Imbuldeniya A M, Walter W K, Zicat B A, Walter W L
Mater Clinic, Specialist Orthopaedic Group, Suite 1.08, Level 1, 3-9 Gillies Street, Wollstonecraft, New South Wales, 2088, Australia.
Bone Joint J. 2014 Jun;96-B(6):730-6. doi: 10.1302/0301-620X.96B6.33381.
We report on 397 consecutive revision total hip replacements in 371 patients with a mean clinical and radiological follow-up of 12.9 years (10 to 17.7). The mean age at surgery was 69 years (37 to 93). A total of 28 patients (8%) underwent further revision, including 16 (4%) femoral components. In all 223 patients (56%, 233 hips) died without further revision and 20 patients (5%, 20 hips) were lost to follow-up. Of the remaining patients, 209 (221 hips) were available for clinical assessment and 194 (205 hips) for radiological review at mean follow-up of 12.9 years (10 to 17.7). The mean Harris Hip Score improved from 58.7 (11 to 92) points to 80.7 (21 to 100) (p < 0.001) and the mean Merle d'Aubigné and Postel hip scores at final follow-up were 4.9 (2 to 6), 4.5 (2 to 6) and 4.3 (2 to 6), respectively for pain, mobility and function. Radiographs showed no lucencies around 186 (90.7%) femoral stems with stable bony ingrowth seen in 199 stems (97%). The survival of the S-ROM femoral stem at 15 years with revision for any reason as the endpoint was 90.5% (95% confidence interval (CI) 85.7 to 93.8) and with revision for aseptic loosening as the endpoint 99.3% (95% CI 97.2 to 99.8). We have shown excellent long-term survivorship and good clinical outcome of a cementless hydroxyapatite proximally-coated modular femoral stem in revision hip surgery.
我们报告了371例患者连续进行的397例全髋关节翻修手术，平均临床和影像学随访时间为12.9年（10至17.7年）。手术时的平均年龄为69岁（37至93岁）。共有28例患者（8%）接受了进一步翻修，其中16例（4%）为股骨组件。在所有223例患者（56%，233髋）中，未进行进一步翻修即死亡，20例患者（5%，20髋）失访。在其余患者中，209例（221髋）可进行临床评估，194例（205髋）可在平均12.9年（10至17.7年）的随访时进行影像学复查。Harris髋关节评分平均从58.7分（11至92分）提高到80.7分（21至100分）（p<0.001），末次随访时Merle d'Aubigné和Postel髋关节评分中，疼痛、活动度和功能评分分别为4.9分（2至6分）、4.5分（2至6分）和4.3分（2至6分）。X线片显示，186例（90.7%）股骨柄周围无透亮区，199例股骨柄（97%）出现稳定的骨长入。以任何原因翻修为终点，S-ROM股骨柄15年生存率为90.5%（95%置信区间（CI）85.7至93.8）；以无菌性松动翻修为终点，生存率为99.3%（95%CI 97.2至99.8）。我们已经证明，在髋关节翻修手术中，一种近端涂有羟基磷灰石的非骨水泥型模块化股骨柄具有出色的长期生存率和良好的临床效果。
