Courtin C, Viste A, Subtil F, Cantin O, Desmarchelier R, Fessy M H
Hospices civils de Lyon, centre hospitalier Lyon-Sud, service de chirurgie orthopédique et traumatologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
Hospices civils de Lyon, centre hospitalier Lyon-Sud, service de chirurgie orthopédique et traumatologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, 69622 Lyon, France; Université Claude-Bernard Lyon-1, 43, boulevard du 11-Novembre, 69100 Villeurbanne, France; IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, 25, Avenue Mitterrand, 69500 Bron, France.
Orthop Traumatol Surg Res. 2017 Feb;103(1):15-19. doi: 10.1016/j.otsr.2016.10.011. Epub 2016 Nov 30.
Increasing the femoral offset when performing total hip arthroplasty (THA) theoretically increases the stresses and risks of the stem not integrating itself into bone. But this concept has not been validated for cementless stems; this led us to conduct a retrospective study to determine: (1) the risk factors for the occurrence of symptomatic femoral radiological abnormalities, (2) the incidence of these abnormal radiological findings, (3) the revision rate for aseptic non-integration of a cementless lateralized stem.
Young patients with significant femoral canal flare and a small cementless lateralized stem have a higher risk of abnormal osseointegration.
We analyzed retrospectively 172 consecutive lateralized stems (KHO, Corail™ product line) implanted during primary THA between 2006 and 2012 in 157 patients (mean age 68years±12.6 (20-95), 89% men). Radiographs were used to evaluate osseointegration scores, offset restoration and the Noble index. Kaplan-Meier survival analysis was performed using "symptomatic femoral radiological abnormalities" and "revision for aseptic stem non-integration" as endpoints.
The mean follow-up was 5.9years±2.7 (range, 2-12.4years). Being more than 70years of age (HR=0.7, 95% CI: [0.3-0.9], P=0.004) and having a larger stem (HR=0.6, 95% CI: [0.4-0.9], P=0.03) were protective against symptomatic femoral radiological abnormalities, while increasing the postoperative femoral offset (HR=1.1, 95% CI: [1.01-1.2], P=0.02) was deleterious. The survival free of "symptomatic femoral radiological abnormalities" was 93% (95% CI: 89-97) at 5years and 84% (95% CI: 75-95) at 8years. The survival free of "revision for aseptic stem non-integration" was 98% (95% CI: 96.8-100) at 5years and 97% (95% CI: 95.2-100) at 8years.
In this study, the risk factors for symptomatic radiological abnormalities were being less than 70years of age, having a small lateralized stem and restoring a large femoral offset. Lateralized stems used in this study had a 10% rate of symptomatic radiological abnormalities and a 4% rate of revision for aseptic non-integration.
IV, retrospective study.
在进行全髋关节置换术（THA）时增加股骨偏心距理论上会增加股骨柄未与骨整合的应力和风险。但这一概念尚未在非骨水泥型股骨柄中得到验证；这促使我们进行一项回顾性研究以确定：（1）出现有症状的股骨放射学异常的危险因素，（2）这些放射学异常发现的发生率，（3）非骨水泥型外侧化股骨柄无菌性未整合的翻修率。
年轻、股骨髓腔显著扩张且使用小型非骨水泥型外侧化股骨柄的患者发生异常骨整合的风险更高。
我们回顾性分析了2006年至2012年间在157例患者（平均年龄68岁±12.6岁（20 - 95岁），89%为男性）初次全髋关节置换术中植入的172个连续外侧化股骨柄（KHO，Corail™产品线）。通过X线片评估骨整合评分、偏心距恢复情况和诺布尔指数。以“有症状的股骨放射学异常”和“无菌性股骨柄未整合翻修”为终点进行Kaplan - Meier生存分析。
平均随访时间为5.9年±2.7年（范围，2 - 12.4年）。年龄超过70岁（HR = 0.7，95%可信区间：[0.3 - 0.9]，P = 0.004）和使用较大尺寸的股骨柄（HR = 0.6，95%可信区间：[0.4 - 0.9]，P = 0.03）对有症状的股骨放射学异常有保护作用，而增加术后股骨偏心距（HR = 1.1，95%可信区间：[1.01 - 1.2]，P = 0.02）则有害。5年时无“有症状的股骨放射学异常”的生存率为93%（95%可信区间：89 - 97），8年时为84%（95%可信区间：75 - 95）。5年时无“无菌性股骨柄未整合翻修”的生存率为98%（95%可信区间：96.8 - 100），8年时为97%（95%可信区间：95.2 - 100）。
在本研究中，有症状的放射学异常的危险因素为年龄小于70岁、使用小型外侧化股骨柄和恢复较大的股骨偏心距。本研究中使用的外侧化股骨柄有症状的放射学异常发生率为10%，无菌性未整合翻修率为4%。
IV级，回顾性研究。
