Sivananthan Sureshan, Lim Chin-Tat, Narkbunnam Rapeepat, Sox-Harris Alex, Huddleston James I, Goodman Stuart B
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California; Department of Orthopaedic Surgery, National University Hospital, Singapore.
J Arthroplasty. 2017 Apr;32(4):1245-1249. doi: 10.1016/j.arth.2016.10.033. Epub 2016 Nov 2.
Modular femoral stem provides flexibility in femoral reconstruction, ensuring improved "fit and fill". However, there are risks of junction failure and corrosion, as well as cost concerns in the use of modular femoral stems.
We reviewed prospectively-gathered clinical and radiographic data on revision total hip arthroplasties (THAs) performed from 2001-2007 using modular, cementless femoral component performed by the 2 senior authors. Patients with a minimum follow-up of 7 years were included in this study.
Sixty-four patients (68 hips) with a median age of 68 ± 14 years (range 40-92 years) at revision THA were included. The median follow-up was 11.0 ± 1.8 years (range 7-14). Harris hip score, femoral stem subsidence, and stem osseointegration were recorded. The Harris hip score improved from an average of 38.1-80.1 (P < .01). Five hips had one or more dislocations. Seven patients underwent reoperations, 3 of which did not involve the stem. Four stems required revision because of infection, recurrent dislocation, or suboptimal implant position. Survival rates for any reasons and revision for femoral stems were 90% and 94%, respectively, at the most recent follow-up. Four stems subsided more than 5 mm, but established stable osseointegration thereafter. Seven nonloose stems (10.2%) demonstrated radiolucent lines in Gruen zones 1 and 7. No complications regarding the modular junction were encountered.
Modular, cementless, extensively porous-coated femoral components have demonstrated intermediate-term clinical and radiographic success. Initial distal intramedullary fixation ensures stability, and proximal modularity further maximizes fit and fill.
模块化股骨柄在股骨重建中提供了灵活性，确保了更好的“贴合与填充”。然而，存在连接失败和腐蚀的风险，以及使用模块化股骨柄的成本问题。
我们回顾了2001年至2007年由两位资深作者使用模块化、非骨水泥股骨组件进行的翻修全髋关节置换术（THA）的前瞻性收集的临床和影像学数据。本研究纳入了至少随访7年的患者。
纳入了64例患者（68髋），翻修THA时的中位年龄为68±14岁（范围40 - 92岁）。中位随访时间为11.0±1.8年（范围7 - 14年）。记录了Harris髋关节评分、股骨柄下沉和柄的骨整合情况。Harris髋关节评分从平均38.1提高到80.1（P <.01）。5髋发生了一次或多次脱位。7例患者接受了再次手术，其中3例不涉及股骨柄。4个股骨柄因感染、反复脱位或植入位置欠佳需要翻修。在最近一次随访时，任何原因导致的生存率和股骨柄翻修率分别为90%和94%。4个股骨柄下沉超过5 mm，但此后建立了稳定的骨整合。7个未松动的股骨柄（10.2%）在Gruen分区1和7显示有透亮线。未遇到与模块化连接相关的并发症。
模块化、非骨水泥、广泛多孔涂层的股骨组件已显示出中期临床和影像学成功。初始的远端髓内固定确保了稳定性，近端模块化进一步优化了贴合与填充。
