Grappiolo Guido, Blaha J D, Gruen T A, Burastero G, Spotorno L
Department of Orthopaedics, West Virginia University, Morgantown, W.V. - USA.
Hip Int. 2002 Apr-Jun;12(2):55-72. doi: 10.1177/112070000201200201.
This report presents the initial experience with the use of a grit-blasted, press-fit femoral prosthesis.
The first 300 consecutive primary total hip arthroplasty procedures using a collarless, three-dimensional tapered, straight, titanium alloy stem with a grit-blasted surface (performed in 299 patients) were evaluated with independent clinical and radiographic follow-up examinations up to sixteen years. Eight different types of acetabular components, including a cementless all-polyethylene socket in 80 percent of the cases, were used. Radiographic evaluation, performed by an independent observer using a zonal analysis method, included assessment of component migration, Enghs implant-bone femoral fixation score, implant-bone demarcations, and periprosthetic osteolysis. The average duration of long-term radiographic follow-up was 12.6 years (range; 10 to 16 years).
At last examination only five hips were lost to follow-up and 69 patients were deceased. The overall mechanical failure rate (i.e. unstable with or without revision) of the femoral component was 2 percent. The femoral revision rate was 7 percent (two hips for aseptic loosening, five hips for septic loosening, and twelve hips with osseointegrated stems for severe progressive femoral osteolysis) and the acetabular revision rate was 27 percent (revised for either socket migration or progressive peri-acetabular osteolysis or both). Survivorship, based on any revision (femoral or acetabular) was 89 percent at ten years and 62 percent at fourteen years; survivorship of the femoral component was 95 percent at ten years and 90 percent at fourteen years. The incidence of femoral periprosthetic osteolysis, by radiographic examination at ten years or more was 47 percent, including 12 hips (5 percent) with distal endosteal osteolysis. Femoral implant-bone fixation was stable, bone-ongrowth in 97 percent; stable, fibrous-fixation in 1 percent, and unstable, fibrous-fixation in 2 percent of the cases.
The grit-blasted, press-fit, collarless, tapered femoral component continued to per-form well clinically and radiographically up to sixteen years of follow-up despite the challenging environment of periprosthetic osteolysis associated with the acetabular component design. The high incidence of failure among the cementless all-polyethylene sockets was not unexpected and the use of this acetabular implant was discontinued in 1985. While considered a "first-generation" cementless stem, this implant is still in use virtually without design modifications. This study demonstrates the durability of the results of the grit-blasted femoral component and indicates that such an implant offers a viable alternative for fixation without bone cement. (Hip International 2002; 2: 55-72).
本报告介绍了使用喷砂处理、压配式股骨假体的初步经验。
对连续进行的首批300例初次全髋关节置换手术进行评估，这些手术使用的是无领、三维锥形、直型、表面喷砂处理的钛合金柄（299例患者接受了该手术），并进行了长达16年的独立临床和影像学随访检查。使用了8种不同类型的髋臼组件，其中80%的病例使用了非骨水泥型全聚乙烯髋臼杯。由一名独立观察者采用分区分析方法进行的影像学评估包括组件移位评估、Enghs种植体-骨股骨固定评分、种植体-骨分界以及假体周围骨溶解情况。长期影像学随访的平均时长为12.6年（范围：10至16年）。
在最后一次检查时，仅有5例髋关节失访，69例患者死亡。股骨组件的总体机械故障率（即无论是否进行翻修均不稳定）为2%。股骨翻修率为7%（2例因无菌性松动、5例因感染性松动、12例骨整合柄因严重进行性股骨骨溶解进行翻修），髋臼翻修率为27%（因髋臼杯移位或进行性髋臼周围骨溶解或两者兼而有之进行翻修）。基于任何翻修（股骨或髋臼）的生存率在10年时为89%，在14年时为62%；股骨组件的生存率在10年时为95%，在14年时为90%。在10年或更长时间进行影像学检查时，股骨假体周围骨溶解的发生率为47%，其中12例髋关节（5%）出现远端骨内膜骨溶解。股骨种植体-骨固定稳定，97%为骨长入；1%为稳定的纤维固定，2%为不稳定的纤维固定。
尽管髋臼组件设计存在假体周围骨溶解这一具有挑战性的情况，但经喷砂处理、压配、无领、锥形的股骨组件在长达16年的随访中，在临床和影像学方面均持续表现良好。非骨水泥型全聚乙烯髋臼杯的高失败率在意料之中，1985年停止使用这种髋臼植入物。虽然该植入物被认为是“第一代”非骨水泥柄，但实际上仍在使用且几乎没有设计上的修改。本研究证明了喷砂处理股骨组件结果的耐久性，并表明这种植入物为无骨水泥固定提供了一种可行的选择。（《国际髋关节》2002年；2：55 - 72）
