Sköldenberg Olof G, Sjöö Helene, Kelly-Pettersson Paula, Bodén Henrik, Eisler Thomas, Stark André, Muren Olle
Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet, Stockholm , Sweden .
Acta Orthop. 2014 Aug;85(4):396-402. doi: 10.3109/17453674.2014.931195. Epub 2014 Jun 23.
We previously evaluated a new uncemented femoral stem designed for elderly patients with a femoral neck fracture and found stable implant fixation and good clinical results up to 2 years postoperatively, despite substantial periprosthetic bone mineral loss. We now present the medium-term follow-up results from this study.
In this observational prospective cohort study, we included 50 patients (mean age 81 (70-92) years) with a femoral neck fracture. All patients underwent surgery with a cemented cup and an uncemented stem specifically designed for fracture treatment. Outcome variables were migration of the stem measured with radiostereometry (RSA) and periprosthetic change in bone mineral density (BMD), measured with dual-energy X-ray absorptiometry (DXA). Hip function and health-related quality of life were assessed using the Harris hip score (HHS) and the EuroQol-5D (EQ-5D). DXA and RSA data were collected at regular intervals up to 4 years, and data concerning reoperations and hip-related complications were collected during a mean follow-up time of 5 (0.2-7.5) years.
At 5 years, 19 patients had either passed away or were unavailable for further participation and 31 could be followed up. Of the original 50 patients, 6 patients had suffered a periprosthetic fracture, all of them sustained after the 2-year follow-up. In 19 patients, we obtained complete RSA and DXA data and no component had migrated after the 2-year follow-up. We also found a continuous total periprosthetic bone loss amounting to a median of -19% (-39 to 2). No changes in HHS or EQ-5D were observed during the follow-up period.
In this medium-term follow-up, the stem remained firmly fixed in bone despite considerable periprosthetic bone mineral loss. However, this bone loss might explain the high number of late-occurring periprosthetic fractures. Based on these results, we would not recommend uncemented femoral stems for the treatment of femoral neck fractures in the elderly.
我们之前评估了一种专为老年股骨颈骨折患者设计的新型非骨水泥型股骨柄，发现尽管假体周围骨量大量丢失，但术后2年内植入物固定稳定且临床效果良好。我们现在展示这项研究的中期随访结果。
在这项观察性前瞻性队列研究中，我们纳入了50例股骨颈骨折患者（平均年龄81（70 - 92）岁）。所有患者均接受了使用骨水泥杯和专为骨折治疗设计的非骨水泥型股骨柄的手术。结局变量包括用放射立体测量法（RSA）测量的股骨柄移位以及用双能X线吸收法（DXA）测量的假体周围骨密度（BMD）变化。使用Harris髋关节评分（HHS）和欧洲五维健康量表（EQ - 5D）评估髋关节功能和与健康相关的生活质量。定期收集长达4年的DXA和RSA数据，并在平均5（0.2 - 7.5）年的随访期内收集有关再次手术和髋关节相关并发症的数据。
5年后，19例患者已去世或无法继续参与研究，31例患者可进行随访。在最初的50例患者中，6例发生了假体周围骨折，均发生在2年随访之后。在19例患者中，我们获得了完整的RSA和DXA数据，且2年随访后没有部件发生移位。我们还发现假体周围总骨量持续丢失，中位数为 - 19%（-39至2）。随访期间未观察到HHS或EQ - 5D有变化。
在本次中期随访中，尽管假体周围骨量大量丢失，但股骨柄在骨内仍保持牢固固定。然而，这种骨量丢失可能解释了晚期发生的大量假体周围骨折。基于这些结果，我们不建议使用非骨水泥型股骨柄治疗老年股骨颈骨折。
