Kwon Young-Min, Antoci Valentin, Eisemon Eric, Tsai Tsung-Yuan, Yan Yu, Liow Ming Han Lincoln
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Arthroplasty. 2016 Dec;31(12):2843-2849. doi: 10.1016/j.arth.2016.05.046. Epub 2016 Jun 17.
Contemporary "dual-taper" modular femoral neck-stem designs have been associated with taper corrosion-related adverse local tissue reaction (ALTR) requiring revision surgery and stem removal. Extended trochanteric osteotomy is recognized as the workhorse procedure for revision hip surgery. The aim of our study is to describe our "top-out" stem removal surgical technique and identify preoperative radiographic risk factors associated with periprosthetic fractures when using this technique.
This is a single-center, single-surgeon, retrospective case series. Operative and clinic records were reviewed for patients with dual-taper modular femoral neck-stem junction who underwent revision surgery for taper tribocorrosion-related ALTR.
Eighty-three patients (36 men and 47 women; mean age, 61.8 ± 10.3; body mass index, 30.2 ± 8.6) were revised using the top-out technique. Significant improvements in postoperative Harris hip score (P = .004), EuroQol 5-dimension questionnaire (EQ-5D; P < .001), and EQ-5D US-adjusted scores (P < .001) were observed at 19-months follow-up. Our study reports periprosthetic fracture incidence of 14% and reoperation rate of 7%. Periprosthetic fractures were positively correlated with radiographic parameters such as overhang distance (R = 0.376; P = .002) and overhang ratio (R = 0.312; P = .01) and negatively correlated with radiographic implant medial calcar prominence (R = -0.299; P = .01).
Removal of well-fixed femoral components can be challenging, and the burden of revision surgery for taper tribocorrosion-related ALTR of these femoral stems is likely to rise. A top-out technique with systematic preoperative planning with radiographs provides a viable, alternative surgical option to remove well-fixed femoral component while preserving the femoral bony envelope.
当代的“双锥度”模块化股骨颈-柄设计与锥度腐蚀相关的局部组织不良反应（ALTR）有关，这需要进行翻修手术并取出假体柄。大转子延长截骨术被认为是髋关节翻修手术的主要术式。我们研究的目的是描述我们的“顶出”假体柄取出手术技术，并确定使用该技术时与假体周围骨折相关的术前影像学风险因素。
这是一项单中心、单术者的回顾性病例系列研究。对因锥度摩擦腐蚀相关的ALTR而接受翻修手术的双锥度模块化股骨颈-柄连接患者的手术和临床记录进行了回顾。
83例患者（36例男性和47例女性；平均年龄61.8±10.3岁；体重指数30.2±8.6）采用顶出技术进行了翻修。在19个月的随访中，术后Harris髋关节评分（P = 0.004）、欧洲五维健康量表（EQ-5D；P < 0.001）和EQ-5D美国校正评分（P < 0.001）均有显著改善。我们的研究报告假体周围骨折发生率为14%，再次手术率为7%。假体周围骨折与影像学参数如悬距（R = 0.376；P = 0.002）和悬距比（R = 0.312；P = 0.01）呈正相关，与影像学植入物内侧骨皮质突出度呈负相关（R = -0.299；P = 0.01）。
取出固定良好的股骨假体组件具有挑战性，并且这些股骨柄因锥度摩擦腐蚀相关的ALTR而进行翻修手术的负担可能会增加。通过术前系统的X线片规划采用顶出技术，为在保留股骨骨膜的同时取出固定良好的股骨组件提供了一种可行的替代手术选择。
