Ollivier M, Parratte S, Galland A, Lunebourg A, Flecher X, Argenson J-N
Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France.
Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France.
Orthop Traumatol Surg Res. 2015 Apr;101(2):137-42. doi: 10.1016/j.otsr.2014.12.013. Epub 2015 Feb 16.
Although they have been in use since the end of the 1980s, modular titanium neck components are associated with a risk of wear or fracture, and their safety has recently become a subject of debate and has never been evaluated in a consecutive series of patients. The goal of this study was to evaluate: revision-free survival of these implants after a minimum follow-up of 5 years; clinical and radiographic results; and the potential complications associated with the use of modular titanium neck components.
The use of titanium modular neck on cemented titanium THA is safe at a minimum follow-up of 5 years.
Between January 2006 and December 2008, we prospectively followed 170 patients (170 hips) who underwent primary anatomical THA with a modular cemented titanium stem design implant. The indications were unilateral THA for primary (n=160) or secondary (n=10) hip osteoarthritis (aseptic osteonecrosis of the femoral head or hip dysplasia). Mean age of patients was 75.4±5.8 years old (52-85), and mean BMI was 26.1±4.5 kg/m(2) (16.6-42.1). Patients were operated on by a modified Watson-Jones anterolateral approach based on preoperative 2D planning. All patients underwent annual clinical and radiological follow-up by an independent observer.
At a mean follow-up of 71±8 months (60-84), 5 patients died and 7 were lost to follow-up. There was no revision of THA after a maximum follow-up of 84 months. The Harris score improved significantly from 50.4±11.3 (0-76) preoperatively to 84.5±15.2 (14-100) at the final follow-up. There was no difference in postoperative femoral offset or the position of the center of rotation compared to the opposite side. On the other hand, the neck-shaft angle (NSA) and limb length were corrected (2±5° [-11 to +14°] and 2.16±3.6 mm [-7.4 to +12.7 mm]) respectively. Fifteen patients (9%) had limb length discrepancies of more than 5 mm and 4 patients (2%) of more than 10 mm. There were no complications due to the modular implant design.
Our study suggests that the use of cemented titanium implants with a modular titanium stem is safe at a follow-up of 5 years. The modular design does not prevent limb length discrepancies but restores femoral offset.
IV: prospective, non-comparative study.
模块化钛制颈部件自20世纪80年代末开始使用，但存在磨损或骨折风险，其安全性最近成为争议话题，且从未在一系列连续患者中进行评估。本研究的目的是评估：这些植入物在至少5年随访后的无翻修生存率；临床和影像学结果；以及使用模块化钛制颈部件相关的潜在并发症。
在至少5年的随访中，在骨水泥固定钛全髋关节置换术中使用钛制模块化颈是安全的。
2006年1月至2008年12月，我们前瞻性地随访了170例（170髋）接受模块化骨水泥固定钛柄设计植入物的初次解剖型全髋关节置换术的患者。适应证为原发性（n = 160）或继发性（n = 10）髋关节骨关节炎（股骨头无菌性坏死或髋关节发育不良）的单侧全髋关节置换术。患者平均年龄为75.4±5.8岁（52 - 85岁），平均体重指数为26.1±4.5 kg/m²（16.6 - 42.1）。患者采用基于术前二维规划的改良Watson-Jones前外侧入路进行手术。所有患者由独立观察者进行年度临床和放射学随访。
平均随访71±8个月（60 - 84个月），5例患者死亡，7例失访。在最长84个月的随访后，无全髋关节置换术翻修病例。Harris评分从术前的50.4±11.3（0 - 76）显著提高到最终随访时的84.5±15.2（14 - 100）。与对侧相比，术后股骨偏心距或旋转中心位置无差异。另一方面，颈干角（NSA）和肢体长度分别得到矫正（2±5°[-11°至+14°]和2.16±3.6 mm[-7.4至+12.7 mm]）。15例患者（9%）肢体长度差异超过5 mm，4例患者（2%）超过10 mm。未出现因模块化植入物设计导致的并发症。
我们的研究表明，在5年的随访中，使用带模块化钛柄骨水泥固定钛植入物是安全的。模块化设计不能防止肢体长度差异，但能恢复股骨偏心距。
IV级：前瞻性非对照研究。
