Goff Thomas A J, Bobak Peter
Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Leeds - UK.
Hip Int. 2017 May 12;27(3):281-285. doi: 10.5301/hipint.5000438. Epub 2017 Feb 1.
Femoral impaction bone allografting in revision hip arthroplasty facilitates physiological reconstruction with restoration of bone stock, allowing implantation of a standard cemented femoral component. The purpose of this study was to report our experience in femoral component revision arthroplasty with impaction morsellised cancellous bone allograft using custom impactors and a cemented triple-taper polished stem.
Retrospective analysis of all cases of femoral component revision hip arthroplasty with impaction bone grafting undertaken by a single surgeon from 2005 to 2011. Outcome measures included radiographic analysis of stem subsidence over time, graft remodelling and incorporation, and clinical progress.
We reviewed 47 consecutive hips in 44 patients, mean age 62 years (37-88). Femoral impaction with allograft was performed as either single stage (41 cases) or 2-stage (6 cases) procedures. All patients received a cemented C-stem prosthesis. The mean follow-up period was 5.1 (1.3-9.4) years. The median preoperative bone defect score was 3 (interquartile range [IQR] 2-3) using the Endo-Klinik classification. Radiological evidence of graft incorporation was observed in 89% (281 of 315 zones) with additional remodelling observed in 33% (103 of 315 zones). The median stem subsidence at 1-year follow-up was 1.1 mm (standard deviation [SD] 1.24 mm, range 0-6 mm). The median Oxford Hip Score at the most recent follow-up was 36.5. To date no femoral component has undergone further revision.
Encouraging results have been obtained with this technique for the treatment of significant bone loss in revision hip arthroplasty, allowing implantation of a standard prosthesis.
在髋关节翻修术中，股骨嵌压植骨可促进骨量恢复的生理性重建，从而能够植入标准的骨水泥型股骨假体。本研究的目的是报告我们使用定制冲击器和骨水泥型三锥度抛光柄，进行嵌压碎骨松质骨移植的股骨假体翻修术的经验。
对2005年至2011年由同一位外科医生进行的所有股骨假体翻修髋关节置换并采用嵌压植骨的病例进行回顾性分析。观察指标包括随着时间推移假体柄下沉的影像学分析、植骨重塑与整合情况以及临床进展。
我们回顾了44例患者的47例连续髋关节病例，平均年龄62岁（37 - 88岁）。同种异体骨股骨嵌压手术分为一期手术（41例）或二期手术（6例）。所有患者均接受了骨水泥型C柄假体。平均随访时间为5.1年（1.3 - 9.4年）。根据Endo-Klinik分类，术前骨缺损评分中位数为3（四分位间距[IQR]2 - 3）。在89%（315个区域中的281个）观察到植骨整合的影像学证据，另外在33%（315个区域中的103个）观察到重塑。1年随访时假体柄下沉的中位数为1.1毫米（标准差[SD]1.24毫米，范围0 - 6毫米）。最近一次随访时牛津髋关节评分中位数为36.5。迄今为止，没有股骨假体需要进一步翻修。
该技术在治疗髋关节翻修术中严重骨丢失方面取得了令人鼓舞的结果，能够植入标准假体。
