Jang Hyung-Gyu, Lee Kyung-Jae, Min Byung-Woo, Ye Hee-Uk, Lim Kyung-Hwan
Department of Orthopedic Surgery, Keimyung University School of Medicine, Daegu, Korea.
Hip Pelvis. 2015 Sep;27(3):135-40. doi: 10.5371/hp.2015.27.3.135. Epub 2015 Sep 30.
The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency.
Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed.
The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up.
Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up.
本研究旨在评估使用模块化远端固定柄治疗股骨近端缺损的翻修全髋关节置换术的临床和影像学结果。
对2006年至2012年间采用模块化远端固定柄进行翻修全髋关节置换术且术后随访超过24个月的45例患者（47髋）进行分析。所有病例均存在股骨近端缺损。术前股骨缺损分类显示，31例为Paprosky II型，7例为IIIA型，9例为IIIB型。平均随访时间为53.4（25 - 100）个月。我们将Harris髋关节评分（HHS）、根据科瓦尔标准评估的行走能力作为临床参数，将柄的稳定性和柄位置的变化作为影像学参数进行评估。采用Kaplan-Meier生存分析。
平均HHS从39.5分提高到91.3分，大多数病例的行走能力也有所改善；所有患者的股骨干固定稳定。术后并发症包括5例感染和2例脱位。以因感染或脱位进行再次翻修手术为终点的8年随访后生存率为86%。
使用模块化股柄的非骨水泥型翻修全髋关节置换术是有效的，因为柄可稳定固定在股骨骨干部分，在中期随访时该部位骨质相对良好。
