Parry Michael C, Vioreanu Mihai H, Garbuz Donald S, Masri Bassam A, Duncan Clive P
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Arthroplasty. 2016 Aug;31(8):1767-72. doi: 10.1016/j.arth.2016.02.007. Epub 2016 Feb 17.
Splined conical stems offer design features that facilitate their use in the misshapen, dysplastic proximal femur.
This study assessed the survivorship of a conical prosthesis when applied to secondary coxarthrosis because of a range of pathologies. Fifty-one prostheses were implanted in 50 patients with a mean age of 50 (range, 15-80) and a median follow-up of 34 months (range, 24-73 months). Indications for the stem included developmental (36), neuromuscular (7), post-traumatic or surgical (7), and inflammatory conditions (1). Survivorship, functional outcome (WOMAC [Western Ontaria and McMaster University Osteoarthrits Index], Oxford Hip Score, and UCLA [University of California Los Angeles]), health status (short form-12 [SF-12]), satisfaction, and osseointegration were determined.
Survivorship for aseptic loosening was 100% at 2 years and 98.04% for septic revision. Eight patients required reoperation, 4 for instability, and 1 each for infection, impingement, adverse reaction to metal debris, and pelvic insufficiency fracture. The mean WOMAC score was 85 (standard deviation [SD], 18), the mean Oxford Hip Score 84 (SD, 18), the mean physical SF-12 score was 48.3 (SD, 8.6), and the mean mental SF-12 was 53.7 (SD, 9.2), the mean satisfaction score was 91.5 (SD, 3.9), and the mean UCLA was 6 (SD, 1.6). All femoral components demonstrated osseointegration.
The cone femoral prosthesis demonstrates excellent early survival and osseointegration when applied to the challenging femur. Because of these encouraging results, we recommend this prosthesis be considered for the small, abnormal femur in primary hip arthroplasty.
花键锥形柄具有一些设计特点，便于在畸形、发育不良的股骨近端使用。
本研究评估了锥形假体应用于因一系列病理情况导致的继发性髋关节病时的生存率。50例患者共植入51个假体，患者平均年龄50岁（范围15 - 80岁），中位随访时间34个月（范围24 - 73个月）。植入柄的适应证包括发育性（36例）、神经肌肉性（7例）、创伤后或手术后（7例）以及炎症性疾病（1例）。确定了生存率、功能结果（WOMAC[西安大略和麦克马斯特大学骨关节炎指数]、牛津髋关节评分以及加州大学洛杉矶分校[UCLA]评分）、健康状况（简明健康状况调查简表-12[SF-12]）、满意度和骨整合情况。
无菌性松动的2年生存率为100%，感染性翻修的生存率为98.04%。8例患者需要再次手术，4例因不稳定，1例因感染、撞击、对金属碎屑的不良反应以及骨盆不全骨折。WOMAC评分均值为85（标准差[SD]，18），牛津髋关节评分均值为84（SD，18），SF-12身体评分均值为48.3（SD，8.6），SF-12心理评分均值为53.7（SD，9.2），满意度评分均值为91.5（SD，3.9），UCLA评分均值为6（SD，1.6）。所有股骨组件均显示骨整合。
锥形股骨假体应用于具有挑战性的股骨时，早期生存率和骨整合情况良好。鉴于这些令人鼓舞的结果，我们建议在初次髋关节置换术中，对于短小、异常的股骨可考虑使用这种假体。
