Te Stroet Martijn A J, Rijnen Wim H C, Gardeniers Jean W M, Van Kampen Albert, Schreurs B Willem
a Department of Orthopaedics , Radboud University Medical Center , Nijmegen , the Netherlands .
Acta Orthop. 2016;87(2):106-12. doi: 10.3109/17453674.2015.1115949. Epub 2015 Nov 16.
Very little has been published on the outcome of femoral cemented revisions using a third-generation cementing technique. We report the medium-term outcome of a consecutive series of patients treated in this way.
This study included 92 consecutive cemented femoral revisions performed in our department with a third-generation cementing technique and without instrumented bone impaction grafting between 1996 and 2007. The average age of the patients at revision was 66 (25-92) years. None of the patients were lost to follow-up. At review in December 2013, 55 patients were still alive and had a non-re-revised femoral revision component in situ after a mean follow-up of 11 (5-17) years.
The mean preoperative Harris hip score was 50, and improved to 73 at final follow-up. 2 patients died shortly after the revision surgery. 1 stem was re-revised for aseptic loosening; this was also the only case with radiolucent lines in all 7 Gruen zones. A femoral reoperation was performed in 19 hips during follow-up, and in 14 of these 19 reoperations the femoral component was re-revised. Survivorship at 10 years, with femoral re-revision for any reason as the endpoint, was 86% (95% CI: 77-92). However, excluding 8 patients with reinfections after septic index revisions and 1 with hematogenous spread of infection from the survival analysis, the adjusted survival for re-revision for any reason at 10 years was 92% (95% CI: 83-96). With re-revision for aseptic loosening as endpoint, the survival at 10 years was 99% (CI: 90-100).
Femoral component revision with a third-generation cemented stem results in acceptable survival after medium-term follow-up. We recommend the use of this technique in femoral revisions with limited loss of bone stock.
关于采用第三代骨水泥技术进行股骨骨水泥翻修术的结果，相关报道甚少。我们报告了采用这种方法连续治疗的一系列患者的中期结果。
本研究纳入了1996年至2007年间在我科采用第三代骨水泥技术且未进行器械辅助骨打压植骨的92例连续股骨骨水泥翻修病例。翻修时患者的平均年龄为66（25 - 92）岁。所有患者均未失访。在2013年12月复查时，55例患者仍存活，平均随访11（5 - 17）年后，原位股骨翻修假体未再次翻修。
术前Harris髋关节评分平均为50分，末次随访时提高到73分。2例患者在翻修手术后不久死亡。1枚假体因无菌性松动进行了再次翻修；这也是所有7个Gruen分区均出现透亮线的唯一病例。随访期间19髋进行了股骨再次手术，其中14例再次手术时股骨假体进行了再次翻修。以因任何原因进行股骨再次翻修为终点，10年生存率为86%（95%可信区间：77 - 92）。然而，生存分析中排除8例感染性指标翻修后再次感染的患者和1例血行性感染播散的患者，10年因任何原因再次翻修的调整生存率为92%（95%可信区间：83 - 96）。以无菌性松动再次翻修为终点，10年生存率为99%（可信区间：90 - 100）。
采用第三代骨水泥柄进行股骨假体翻修，中期随访后生存率可接受。我们建议在骨量丢失有限的股骨翻修中使用该技术。
