Cantin O, Viste A, Desmarchelier R, Besse J-L, Fessy M H
Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France.
Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, Lyon, France; IFSTTAR, UMRT_9406, laboratoire de biomecanique et mécanique des chocs, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
Orthop Traumatol Surg Res. 2015 Nov;101(7):775-80. doi: 10.1016/j.otsr.2015.08.002. Epub 2015 Oct 23.
Restoring the native hip anatomy increases hip prosthesis survival, whereas increased femoral lateralisation creates high torque stresses that may alter prosthesis fixation. After finding lucent lines around cementless lateralised stems (Corail™, DePuy Synthes, St Priest, France) in several patients, we evaluated the effects of lateralisation in a large case-series. The objective of our study was to compare lateralised vs standard stems of identical design in terms of radiological osteo-integration and survival.
Lateralised stems, despite being used only when indicated by the anatomical parameters, carry a higher risk of impaired osteo-integration.
A retrospective study was conducted in 807 primary total hip arthroplasties (THAs) performed between 2006 and 2010 in 798 patients with a mean age of 65 ± 14.2 years. Lateralised stems were used in 280 cases (Corail High Offset KHO, n = 169; and Corail coxa vara KLA, n = 111 cases) and standard stems in 527 cases (Corail KA). Mean follow-up was 2.3 years (range, 1-7 years). The clinical evaluation included determination of the Postel-Merle d'Aubigné (PMA) score. Bone fixation and stability of the implants were assessed by determining the Engh and Massin score and the ARA score on the radiographs at last follow-up. Femoral, acetabular and global offset values were determined before and after THA. Nobles's Canal Flare Index was computed. Survival was estimated using the Kaplan-Meier method with surgical revision for aseptic loosening as the end-point.
The PMA score improved from 12 (10-15) pre-operatively to 17.7 (14-18) (P < 0.05). After THA, in the lateralised stem group, femoral offset was restored in 217 (77%) hips and the mean change vs the pre-operative offset value was -2 mm; in the standard stem group, femoral offset was restored in 440 (83.5%) hips and the mean change was +1 mm. The Engh and Massin score values were similar in the standard stem and lateralised stem groups (24.4 ± 2.2 and 22.6 ± 2.4, respectively, NS). Revision for aseptic loosening was required in 5 patients with lateralised stems (3 KHO and 2 KLA) versus none of the patients with standard stems. There were no cases of excessive femoral offset and the mean change in offset was -2.3mm (-5.3 to -1.1). Noble's index was increased (4.27 ± 0.5 for the loosened lateralised stems, 3.65 ± 0.8 for the well-fixed lateralised stems and 3.82 ± 0.6 for the standard stems), with no significant difference across groups. Overall survival after 3.5 years of follow-up was 94.6% (95% confidence interval, 88.4-100%) with lateralised stems and 100% with standard stems (P < 0.05).
The risk of aseptic loosening was significantly higher with the lateralised stem (5/280, 1.8%) than with the standard stem (n = 0). Our findings indicate a need for careful preparation to obtain primary fixation of lateralised stems.
III, retrospective case-control study.
恢复髋关节原生解剖结构可提高髋关节假体的生存率，而股骨侧移增加会产生高扭矩应力，可能改变假体固定。在数名患者的非骨水泥侧移柄（Corail™，德普伊辛迪思公司，法国圣普列斯特）周围发现透亮线后，我们在一个大型病例系列中评估了侧移的影响。我们研究的目的是比较相同设计的侧移柄与标准柄在放射学骨整合和生存率方面的差异。
尽管侧移柄仅在解剖参数表明有必要时使用，但骨整合受损的风险更高。
对2006年至2010年期间798例平均年龄为65±14.2岁的患者实施的807例初次全髋关节置换术（THA）进行回顾性研究。280例使用侧移柄（Corail高偏移KHO，n = 169；Corail髋内翻KLA，n = 111例），527例使用标准柄（Corail KA）。平均随访时间为2.3年（范围1 - 7年）。临床评估包括确定Postel-Merle d'Aubigné（PMA）评分。通过在最后一次随访时的X线片上确定Engh和Massin评分以及ARA评分来评估植入物的骨固定和稳定性。在全髋关节置换术前和术后测定股骨、髋臼和整体偏移值。计算Nobles's Canal Flare指数。采用Kaplan-Meier方法估计生存率，以无菌性松动的手术翻修为终点。
PMA评分从术前的12分（10 - 15分）提高到17.7分（14 - 18分）（P < 0.05）。全髋关节置换术后，在侧移柄组中，217例（77%）髋关节的股骨偏移得到恢复，与术前偏移值相比平均变化为 - 2mm；在标准柄组中，440例（83.5%）髋关节的股骨偏移得到恢复，平均变化为 + 1mm。标准柄组和侧移柄组的Engh和Massin评分值相似（分别为24.4±2.2和22.6±2.4，无显著性差异）。5例使用侧移柄的患者（3例KHO和2例KLA）需要进行无菌性松动翻修，而使用标准柄的患者无一例需要翻修。没有出现股骨偏移过度的情况，偏移的平均变化为 - 2.3mm（ - 5.3至 - 1.1）。Noble指数增加（松动的侧移柄为4.27±0.5，固定良好的侧移柄为3.65±0.8，标准柄为3.82±0.6），各组间无显著差异。随访3.5年后，侧移柄组的总体生存率为94.6%（95%置信区间，88.4 - 100%），标准柄组为100%（P < 0.05）。
侧移柄无菌性松动的风险（5/280，1.8%）显著高于标准柄（n = 0）。我们的研究结果表明，需要仔细准备以实现侧移柄的初次固定。
III级，回顾性病例对照研究。
