Solomon L B, Costi K, Kosuge D, Cordier T, McGee M A, Howie D W
Royal Adelaide Hospital, L4 Bice Building, North Terrace, Adelaide, South Australia 5000, Australia.
The Princess Alexandra Hospital, Hamstel Road, Harlow CM20 1QX, Essex, UK.
Bone Joint J. 2015 Aug;97-B(8):1038-45. doi: 10.1302/0301-620X.97B8.34632.
The outcome of 219 revision total hip arthroplasties (THAs) in 98 male and 121 female patients, using 137 long length and 82 standard length cemented collarless double-taper femoral stems in 211 patients, with a mean age of 72 years (30 to 90) and mean follow-up of six years (two to 18) have been described previously. We have extended the follow-up to a mean of 13 years (8 to 20) in this cohort of patients in which the pre-operative bone deficiency Paprosky grading was IIIA or worse in 79% and 73% of femurs with long and standard stems, respectively. For the long stem revision group, survival to re-revision for aseptic loosening at 14 years was 97% (95% confidence interval (CI) 91 to 100) and in patients aged > 70 years, survival was 100%. Two patients (two revisions) were lost to follow-up and 86 patients with 88 revisions had died. Worst-case analysis for survival to re-revision for aseptic loosening at 14 years was 95% (95% CI 89 to 100) and 99% (95% CI 96 to 100) for patients aged > 70 years. One additional long stem was classified as loose radiographically but not revised. For the standard stem revision group, survival to re-revision for aseptic loosening at 14 years was 91% (95% CI 83 to 99). No patients were lost to follow-up and 49 patients with 51 hips had died. No additional stems were classified as loose radiographically. Femoral revision using a cemented collarless double-taper stem, particularly with a long length stem, and in patients aged > 70 years, continues to yield excellent results up to 20 years post-operatively, including in hips with considerable femoral metaphyseal bone loss.
此前已报道了98例男性和121例女性患者共219例全髋关节翻修术（THA）的结果，其中211例患者使用了137根长柄和82根标准柄的骨水泥型无领双锥股骨柄，平均年龄72岁（30至90岁），平均随访6年（2至18年）。在该队列患者中，我们将随访时间延长至平均13年（8至20年），其中长柄和标准柄股骨术前骨缺损Paprosky分级分别为IIIA级或更差的比例为79%和73%。对于长柄翻修组，14年时无菌性松动再次翻修的生存率为97%（95%置信区间（CI）91至100），70岁以上患者的生存率为100%。2例患者（2次翻修）失访，86例患者88次翻修后死亡。70岁以上患者14年时无菌性松动再次翻修生存率的最坏情况分析为95%（95%CI 89至100）和99%（95%CI 96至100）。另外1根长柄在影像学上被归类为松动但未进行翻修。对于标准柄翻修组，14年时无菌性松动再次翻修的生存率为91%（95%CI 83至99）。无患者失访，49例患者51髋死亡。影像学上无额外的柄被归类为松动。使用骨水泥型无领双锥柄进行股骨翻修，特别是长柄，在70岁以上患者中，术后20年仍能取得优异结果，包括股骨近端有大量骨质丢失的髋关节。
