De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S
General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy.
General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy.
Orthop Traumatol Surg Res. 2017 May;103(3):349-355. doi: 10.1016/j.otsr.2016.12.013. Epub 2017 Jan 31.
Benefits of femoral offset restoration during total hip arthroplasty should be the reduction of bearing surfaces wear, implant loosening and dislocation rates. Modular neck stems ensure offset customization but fretting corrosion and catastrophic failures are well-documented complications. Since clinical evidences are needed to substantiate the effectiveness of femoral offset restoration and promote modular neck choice, we systematically reviewed the literature to ascertain whether femoral offset itself has a proven clinical influence: (1) on bearing surfaces wear, (2) implant loosening, (3) and dislocation rates. A systematic literature screening was conducted to find papers dealing with the influence of femoral offset on wear, dislocation and loosening, including articles with conventional radiographic femoral offset assessment and with comparative design. Observational studies, case reports, instructional course lectures, cadaveric and animal studies as well as biomechanical studies, letters to the editor, surgical techniques or technical notes were all excluded. No limits about publication date were supplied but only papers in English were taken into account. Data were extracted into an anonymous spreadsheet. Offset values, dislocation rates, wear rates, follow-up and surgical approaches were all detailed. Ten manuscripts were finally selected. A statistically significant correlation between femoral offset restoration and the reduction of conventional ultrahigh-molecular-weight polyethylene wear was found in two out of three papers investigating this issue, but no correlations were found between femoral offset and dislocation rates or implant loosening. Femoral offset modification influences ultrahigh-molecular-weight polyethylene liners wear, but no correlation was found with dislocation rates or implant loosening. Advantages on wear can be counterbalanced by the use of hard bearing surfaces or highly cross-linked polyethylene liners, besides the availability of larger femoral heads improving implant stability further reduces the importance of femoral offset restoration by means of modularity. We believe that efforts in restoring femoral offset during total hip arthroplasty do not translate into tangible clinical profits and consequently, we do not advise the routinely usage of modular neck stems in total hip arthroplasty.
level III, systematic review of case-control studies.
全髋关节置换术中恢复股骨偏心距的益处应是减少关节面磨损、植入物松动和脱位率。模块化颈干可确保偏心距定制，但微动腐蚀和灾难性故障是有充分文献记载并发症。由于需要临床证据来证实恢复股骨偏心距的有效性并促进模块化颈的选择，我们系统回顾了文献，以确定股骨偏心距本身是否对以下方面有已证实的临床影响：（1）关节面磨损，（2）植入物松动，（3）脱位率。进行了系统的文献筛选，以查找论述股骨偏心距对磨损、脱位和松动影响的论文，包括采用传统X线片评估股骨偏心距以及采用对比设计的文章。观察性研究、病例报告、教学课程讲座、尸体和动物研究以及生物力学研究、给编辑的信、手术技术或技术说明均被排除。未设定出版日期限制，但仅纳入英文论文。数据被提取到一个匿名电子表格中。详细记录了偏心距值、脱位率、磨损率、随访情况和手术入路。最终选定了10篇手稿。在研究此问题的三篇论文中有两篇发现股骨偏心距恢复与传统超高分子量聚乙烯磨损减少之间存在统计学显著相关性，但未发现股骨偏心距与脱位率或植入物松动之间存在相关性。股骨偏心距修正会影响超高分子量聚乙烯衬垫磨损，但未发现与脱位率或植入物松动存在相关性。除了使用硬关节面或高度交联聚乙烯衬垫可抵消对磨损的益处外，更大股骨头的可用性进一步提高了植入物稳定性，降低了通过模块化恢复股骨偏心距的重要性。我们认为，全髋关节置换术中恢复股骨偏心距的努力并未转化为切实的临床益处，因此，我们不建议在全髋关节置换术中常规使用模块化颈干。
III级，病例对照研究的系统评价。
