Giebaly Dia Eldean, Twaij Haider, Ibrahim Mazin, Haddad Fares S
University College London Hospital, London - UK.
Imperial College Healthcare NHS Trust, London - UK.
Hip Int. 2016 Sep 29;26(5):413-423. doi: 10.5301/hipint.5000423. Epub 2016 Sep 22.
Total hip replacement is a successful procedure with long survival records compared to other joint arthroplasties. Cemented implants have been available for many years, however the complications associated with loosening and, ultimately, failure over time has led to the development of cementless stems and implants.The ideal prosthesis should recreate a biomechanically normal hip joint, allow pain-free function and last the patient's life span without requiring revision. Optimal results with uncemented femoral stems rely on obtaining initial stability, osseointegration, biological fixation, and uniform stress transfer to the proximal bone.There are a multitude of factors that can affect the integration, stability and fixation of these stems into bone, and understanding these factors is the key to choosing the appropriate implant for a specific femur.
This article aims to discuss cementless prostheses based on evidence-based practice. Geometry, roughness, stem coating, technique and bone quality are among the factors discussed. This was achieved through a review of the current literature.
Uncemented femoral stems have shown good, long-term survivorship and functional outcome, with promising results in younger patients.Limitations in the current literature make it difficult to assess and compare different designs to determine optimal indications for each type.Biological fixation, in which the prosthesis is directly fixed to the bone, is the preferred fixation method.Future studies of cementless implants should consistently address patient age, activity level, bone type, and deformities so that more definitive conclusions can be drawn about when to use each design.
与其他关节置换术相比，全髋关节置换术是一种成功的手术，具有较长的存活记录。骨水泥型植入物已经应用多年，然而，随着时间的推移，与松动以及最终失败相关的并发症促使了非骨水泥型股骨柄和植入物的发展。理想的假体应重建生物力学正常的髋关节，实现无痛功能，并在患者的寿命期内无需翻修。非骨水泥型股骨柄的最佳效果依赖于获得初始稳定性、骨整合、生物固定以及向近端骨的均匀应力传递。有许多因素会影响这些股骨柄与骨的整合、稳定性和固定，了解这些因素是为特定股骨选择合适植入物的关键。
本文旨在基于循证医学实践讨论非骨水泥型假体。所讨论的因素包括几何形状、粗糙度、股骨柄涂层、技术和骨质。这是通过对当前文献的综述来实现的。
非骨水泥型股骨柄已显示出良好的长期生存率和功能结果，在年轻患者中取得了令人鼓舞的成果。当前文献的局限性使得难以评估和比较不同设计以确定每种类型的最佳适应证。生物固定，即假体直接固定于骨，是首选的固定方法。未来对非骨水泥型植入物的研究应始终关注患者年龄、活动水平、骨类型和畸形情况，以便能够就何时使用每种设计得出更明确的结论。
