Meding John B, Ritter Merrill A, Keating E Michael, Berend Michael E
The Center for Hip and Knee Surgery, 1199 Hadley Road, Mooresville, IN, 46158, USA,
Clin Orthop Relat Res. 2015 Feb;473(2):543-8. doi: 10.1007/s11999-014-3763-y.
Uncemented stems have been used in THA for well over two decades, but there are relatively few studies reporting on the results after 20 years.
QUESTIONS/PURPOSES: The purpose of this study was to evaluate at a minimum followup of 20 years (1) hip scores; (2) radiographic findings, including stem fixation and osteolysis; (3) reoperations; and (4) survivorship free from aseptic loosening in a group of patients who underwent primary THA using a proximally porous-coated, plasma-sprayed, straight-stemmed, titanium-alloy femoral component.
Between 1987 and 1993, we performed 1517 primary THAs, of which 447 were cementless, and 157 used the implant under study here (representing 10% of the THAs during the period in question). General indications for the use of the study stem included (1) younger age with relatively stronger bone (average age 55 years in this study); (2) patients not involved in another study protocol (as were the 278 other cementless hips implanted during this time); and (3) patients who, at the surgeon's discretion, would be compliant with protected weightbearing. Of those, 111 were available for followup at a minimum of 20 years (mean, 20 years), whereas 36 had died and nine (6%) were lost to followup or declined participation. The primary diagnosis was osteoarthritis in 77 hips (69%). The mean age at operation was 55 years. The clinical result was evaluated on the basis of the Harris hip score. Radiographic analysis was performed at each followup visit for distal cortical hypertrophy, spot welds, radiolucencies, stem subsidence, varus or valgus shift, osteolysis, and femoral component loosening. Kaplan-Meier analysis was performed to evaluate the survival of the femoral component.
The mean Harris hip score improved from 46 points to 87 points (of a possible 100 points) at the most recent followup. All hips had evidence of proximal femoral remodeling consistent with osseous ingrowth. Femoral osteolyis was seen in 22 hips (20%). One stem was revised as a result of a periprosthetic fracture. No femoral component had evidence of loosening, and none was revised. Thirty-three acetabular components (30%) were revised.
This femoral component provided durable long-term fixation for over two decades after THA. The porous stem geometry is still in use today and will continue to be studied into the third decade of use.
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
非骨水泥型股骨柄用于全髋关节置换术（THA）已有二十多年，但关于20年后结果的研究相对较少。
问题/目的：本研究的目的是在至少20年的随访中评估（1）髋关节评分；（2）影像学表现，包括股骨柄固定和骨溶解；（3）再次手术情况；（4）一组使用近端多孔涂层、等离子喷涂、直柄钛合金股骨组件进行初次THA的患者中无无菌性松动的假体生存率。
1987年至1993年间，我们共进行了1517例初次THA，其中447例为非骨水泥型，157例使用了本研究中的植入物（占该时期THA的10%）。使用该研究股骨柄的一般指征包括：（1）年龄较轻且骨质相对较强（本研究中平均年龄55岁）；（2）未参与其他研究方案的患者（同期植入的另外278例非骨水泥型髋关节患者参与了其他研究）；（3）经外科医生判断能遵守保护性负重的患者。其中，111例患者至少随访了20年（平均20年），36例患者死亡，9例（6%）失访或拒绝参与。77例（69%）的主要诊断为骨关节炎。手术时的平均年龄为55岁。根据Harris髋关节评分评估临床结果。每次随访时进行影像学分析，评估远端皮质肥大、点焊、透亮区、股骨柄下沉、内翻或外翻移位、骨溶解以及股骨组件松动情况。采用Kaplan-Meier分析评估股骨组件的生存率。
在最近一次随访时，Harris髋关节评分的平均值从46分提高到了87分（满分100分）。所有髋关节均有与骨长入一致的股骨近端重塑迹象。22例（20%）髋关节出现股骨骨溶解。1例股骨柄因假体周围骨折而翻修。无股骨组件出现松动迹象，也无股骨组件翻修情况。33例髋臼组件（30%）进行了翻修。
该股骨组件在THA后提供了超过二十年的持久长期固定。多孔股骨柄的设计如今仍在使用，并将在其使用的第三个十年继续接受研究。
IV级，治疗性研究。有关证据水平的完整描述，请参阅《作者须知》。
