Schilcher Jörg, Ivarsson Ingemar, Perlbach Rico, Palm Lars
Department of Experimental and Clinical Medicine and the Department of Orthopedics, Faculty of Health Science, Linköping University, Linköping, Sweden.
J Arthroplasty. 2017 Apr;32(4):1220-1226. doi: 10.1016/j.arth.2016.11.015. Epub 2016 Nov 17.
Cementless femoral stems in total hip arthroplasty provide dependable clinical and radiographic results in the treatment of osteoarthritis. Stem length might affect the preservation of proximal bone stock and stability. We hypothesized that a shorter stem decreases proximal bone loss without affecting implant stability.
We randomly assigned 60 patients aged between 50 and 70 years to either a standard cementless femoral stem or a 35-mm shorter version. Patients were followed with dual-energy X-ray absorptiometry, radiostereometric analysis, Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, and clinical follow-up at 3, 6, 12, and 24 months. The trial is registered on ClinicalTrials.gov/.
After 24 months, short stems had on average 3.8% (95% confidence interval, 1.2%-8.9%) more bone loss in zone 1 compared to standard stems (P = .14). In zone 7, the bone loss was on average 6.5% (95% confidence interval, 6.6%-19.7%) higher compared to standard stems (P = .33). After 24 months, standard stems had migrated 0.93 mm (range, 0.25-4.66 mm) and short stems 0.93 mm (range, 0.17-2.96 mm; Student t-test after log transformation, P = .3). Patient-reported outcome measures were similar in both groups. One patient in the standard stem group was diagnosed with infection, one with a posterior dislocation, and one with a deep venous thrombosis. No stems were revised.
There were no statistically significant differences in periprosthetic bone loss or fixation between the stems at 24 months.
全髋关节置换术中的非骨水泥型股骨柄在骨关节炎治疗中可提供可靠的临床和影像学结果。股骨柄长度可能会影响近端骨量的保留和稳定性。我们假设较短的股骨柄可减少近端骨丢失，且不影响植入物稳定性。
我们将60例年龄在50至70岁之间的患者随机分为接受标准非骨水泥型股骨柄或短35毫米版本股骨柄的两组。通过双能X线吸收法、放射立体测量分析、Harris髋关节评分、西安大略和麦克马斯特大学骨关节炎指数评分以及在3、6、12和24个月时的临床随访对患者进行跟踪。该试验已在ClinicalTrials.gov/上注册。
24个月后，与标准股骨柄相比，短股骨柄在1区的骨丢失平均多3.8%（95%置信区间，1.2%-8.9%）（P = 0.14）。在7区，与标准股骨柄相比，骨丢失平均高6.5%（95%置信区间，6.6%-19.7%）（P = 0.33）。24个月后，标准股骨柄移位了0.93毫米（范围，0.25-4.66毫米），短股骨柄移位了0.93毫米（范围, 0.17-2.96毫米；对数转换后的Student t检验，P = 0.3）。两组患者报告的结局指标相似。标准股骨柄组有1例患者被诊断为感染，1例发生后脱位，1例发生深静脉血栓形成。没有股骨柄进行翻修。
24个月时，两种股骨柄周围的骨丢失或固定情况在统计学上无显著差异。
