Zhang Zhen-Dong, Zhuo Qi, Zhang Qing-Meng, Song Jun-Lei, Chen Ji-Ying
Zhongguo Gu Shang. 2015 Mar;28(3):198-204.
To investigate and clarify the key surgical techniques and evaluate clinical effectiveness of modular cementless femoral stems(LINK MP modular stem) in complex revision hip arthroplasty.
From January 2002 to December 2013, 470 patients in Chinese PLA General Hospital received revision hip arthroplasties using MP stems. Among them, 246 patients were followed for an average of 5.7 years (ranged, 0.5 to 11 years). There were 148 males and 98 females, with an average age of 62.5 years old (ranged from 26 to 83 years old). The most common reason for revision was aseptic loosening of femoral stems (107 cases, 43.5%), followed by prosthetic joint infection (104 cases, 42.3%). Other reasons included unexplained hip or thigh pain, periprosthetic femoral fracture, prosthesis wear and dislocation. According to Paprosky classification of femoral deficiency, there were 171 cases of type IIIA (69.5%), 14 cases of type I, 39 cases of type II, and 22 cases of type IIIB. The average preoperative Harris hip score (HHS) was 37.4 ± 7.5. In addition, radiographic presentation, degree of patients' subjective satisfaction, and clinical effectiveness were assessed as well.
The average Harris score was im- proved to 87.8 ± 4.2 after operation,with significant statistical difference when compared to preoperative score (t = 92.13,P = 0.00). Analysis of patients' subjective satisfaction for leg length discrepancy, stability and overall degree of satisfaction showed that the number of patients with great satisfaction were 27, 60, 61 respectively. The most common complication was the periprosthetic fracture (intraoperatively 21 cases and postoperatively 8 cases). Other complications included infection (7 cases), dislocation (5 cases), numbness possibly caused by incomplete sciatic nerve injury (6 cases) and thigh swelling (3 cases). The X-ray taken at the final follow-up revealed that prosthesis subsidence occurred in 4 cases, 2 of which needed a second revision.
The application of modular cementless femoral stems (LINK MP modular stem) in complex revision hip arthroplasty (especially in cases with the serious defect of proximal femoral bone) shows good results at both the short-term and long-term follow-up, especially in the revision for prosthetic infection with the high success rate. In order to avoid complications and improve clinical outcomes,the surgeons should carefully select proper surgery candidates,perform the procedure with care, and master the key surgical techniques.
探讨并阐明模块化非骨水泥型股骨柄（LINK MP模块化柄）在复杂髋关节翻修术中的关键手术技术，并评估其临床疗效。
2002年1月至2013年12月，中国人民解放军总医院470例患者接受了使用MP柄的髋关节翻修术。其中，246例患者获得平均5.7年（范围0.5至11年）的随访。男性148例，女性98例，平均年龄62.5岁（范围26至83岁）。翻修的最常见原因是股骨柄无菌性松动（107例，43.5%），其次是人工关节感染（104例，42.3%）。其他原因包括不明原因的髋部或大腿疼痛、假体周围股骨骨折、假体磨损和脱位。根据Paprosky股骨缺损分类，IIIA型171例（69.5%），I型14例，II型39例，IIIB型22例。术前Harris髋关节评分（HHS）平均为37.4±7.5。此外，还评估了影像学表现、患者主观满意度程度和临床疗效。
术后Harris评分平均提高到87.8±4.2，与术前评分相比有显著统计学差异（t = 92.13，P = 0.00）。对患者在肢体长度差异、稳定性和总体满意度方面的主观满意度分析显示，非常满意的患者人数分别为27例、60例、61例。最常见的并发症是假体周围骨折（术中21例，术后8例）。其他并发症包括感染（7例）、脱位（5例）、坐骨神经损伤不完全可能导致的麻木（6例）和大腿肿胀（3例）。末次随访时的X线片显示4例发生假体下沉，其中2例需要二次翻修。
模块化非骨水泥型股骨柄（LINK MP模块化柄）在复杂髋关节翻修术（尤其是股骨近端严重骨缺损病例）中的应用在短期和长期随访中均显示出良好效果，特别是在翻修假体感染方面成功率较高。为避免并发症并改善临床结果，外科医生应仔细选择合适的手术患者，谨慎进行手术操作，并掌握关键手术技术。
