Viste A, Perry K I, Taunton M J, Hanssen A D, Abdel M P
Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
Bone Joint J. 2017 Mar;99-B(3):325-329. doi: 10.1302/0301-620X.99B3.BJJ-2016-0822.R1.
Loss or absence of proximal femoral bone in revision total hip arthroplasty (THA) remains a significant challenge. While the main indication for the use of proximal femoral replacements (PFRs) is in the treatment of malignant disease, they have a valuable role in revision THA for loosening, fracture and infection in patients with bone loss. Our aim was to determine the clinical outcomes, implant survivorship, and complications of PFRs used in revision THA for indications other than malignancy.
A retrospective review of 44 patients who underwent revision THA using a PFR between 2000 and 2013 was undertaken. Their mean age was 79 years (53 to 97); 31 (70%) were women. The bone loss was classified as Paprosky IIIB or IV in all patients. The mean follow-up was six years (2 to 12), at which time 22 patients had died and five were lost to follow-up.
The mean Harris Hip Score improved from 42.8 (25.9 to 82.9) pre-operatively to 68.5 (21.0 to 87.7) post-operatively (p = 0.0009). A total of two PFRs had been revised, one for periprosthetic infection eight years post-operatively and one for aseptic loosening six years post-operatively. The Kaplan-Meier survivorship free of any revision or removal of an implant was 86% at five years and 66% years at ten years. A total of 12 patients (27%) had a complication including six with a dislocation.
PFRs provide a useful salvage option for patients, particularly the elderly with massive proximal femoral bone loss who require revision THA, with significant clinical improvement. While the survivorship of the implant is good at five years, dislocation continues to be the most common complication. The judicious use of larger femoral heads, dual-mobility constructs, or constrained liners may help to minimise the risk of dislocation. Cite this article: 2017;99-B:325-9.
在翻修全髋关节置换术（THA）中，股骨近端骨丢失或缺失仍然是一项重大挑战。虽然使用股骨近端置换物（PFR）的主要指征是治疗恶性疾病，但它们在因骨丢失导致松动、骨折和感染的翻修THA中也发挥着重要作用。我们的目的是确定用于非恶性指征的翻修THA中的PFR的临床结果、植入物生存率和并发症。
对2000年至2013年间接受使用PFR进行翻修THA的44例患者进行回顾性研究。他们的平均年龄为79岁（53至97岁）；31例（70%）为女性。所有患者的骨丢失均分类为Paprosky IIIB或IV型。平均随访时间为6年（2至12年），此时22例患者死亡，5例失访。
Harris髋关节平均评分从术前的42.8（25.9至82.9）提高到术后的68.5（21.0至87.7）（p = 0.0009）。共有2个PFR进行了翻修，1个是术后8年因假体周围感染，1个是术后6年因无菌性松动。 Kaplan-Meier法计算的无植入物翻修或取出的生存率在5年时为86%，10年时为66%。共有12例患者（27%）出现并发症，其中6例发生脱位。
PFR为患者，特别是需要翻修THA的股骨近端大量骨丢失的老年患者提供了一种有用的挽救选择，临床症状有显著改善。虽然植入物在5年时生存率良好，但脱位仍然是最常见的并发症。明智地使用较大的股骨头、双动结构或限制性衬垫可能有助于将脱位风险降至最低。引用本文：2017；99-B：325-9。
