Louboutin L, Viste A, Desmarchelier R, Fessy M-H
Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
Service de chirurgie orthopédique et traumatologique, hospices civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, 69622 Lyon, France; Université Claude Bernard Lyon 1, 43, boulevard du 11 Novembre, 69100 Villeurbanne, France; IFSTTAR, UMRT_9406, laboratoire de biomécanique et mécanique des Chocs, 25, avenue Mitterrand, 69500 Bron, France.
Orthop Traumatol Surg Res. 2017 Nov;103(7):987-992. doi: 10.1016/j.otsr.2017.06.010. Epub 2017 Aug 1.
The Corail™ stem, which was first introduced in 1986, has since been modified twice: first to make the neck thinner and then to change the location of the laser markings. The survival and complications of the first-generation straight, titanium, hydroxyapatite-coated stem are known; however, there is little specific information about the latest-generation stem. This led us to conduct a retrospective study to determine the: (1) long-term survival; (2) clinical and radiographic outcomes; (3) complications; and (4) risk factors for revision of the newest Corail™ stem.
The newest Corail™ AMT (Articul/EZE™ Mini Taper) standard stem has comparable survival to prior models.
This single-center, retrospective study included 133 patients (140 hips), who underwent primary total hip arthroplasty (THA), between January and December 2004, in which a Corail™ Standard stem was implanted using a posterolateral approach. Patients who underwent revision THA, THA due to femoral neck fracture or who received lateralized (offset) stems were excluded. The mean age at the time of THA was 69±13 years [35-92] in 85 men (61%) and 55 women (39%) who had a mean BMI of 27kg/m±11 [16-39]. At the latest follow-up, 32 patients (32 hips) had died and 8 patients (8 hips) had less than 3 years' follow-up, thus were not included in the clinical evaluation. The Merle d'Aubigné (PMA) score was collected. The stem's survivorship was calculated using the Kaplan-Meier method with revision for aseptic loosening and revision or implant removal for any reason as the end-points. The Cox model was used to analyze risk factors for revision. The mean follow-up was 10±3 years [3-12].
The PMA score was 12±2.6 [5-17] preoperatively and 16±2.7 [7-18] at the last follow-up (P<0.00001). Eighteen complications (12.8%) were recorded at the last follow-up. There were 15 early complications: 6 dislocations, 5 calcar fractures (4 treated by wire cerclage and 1 by stem change plus wire cerclage), 2 greater trochanter fractures (treated non-surgically) and 2 cases of sciatic nerve palsy. There were 3 late complications: 2 cases of iliopsoas irritation and 1 ceramic insert fracture. Stem survival for surgical revision due to aseptic loosening was 98% (95% CI: [0.96-1]). At 12 years, 95% of stems had not been revised or removed (95% CI: [0.92-0.99]). Being less than 58 years of age at the time of surgery was the only risk factor significantly associated with stem revision for any reason (P=0.04).
Survival of the Corail™ Standard stem is similar to that of previous generation stems. The changes made in this stem solved the neck failure problem and did not induce new complications.
Level IV (retrospective study).
Corail™ 股骨柄于1986年首次推出，此后进行了两次改进：第一次是使颈部变细，第二次是改变激光标记的位置。第一代直柄、钛制、羟基磷灰石涂层股骨柄的生存率和并发症情况已知；然而，关于最新一代股骨柄的具体信息很少。这促使我们进行一项回顾性研究，以确定：（1）长期生存率；（2）临床和影像学结果；（3）并发症；以及（4）最新款Corail™ 股骨柄翻修的危险因素。
最新款Corail™ AMT（Articul/EZE™ 微型锥度）标准股骨柄的生存率与先前型号相当。
这项单中心回顾性研究纳入了2004年1月至12月期间接受初次全髋关节置换术（THA）的133例患者（140髋），采用后外侧入路植入Corail™ 标准股骨柄。排除接受翻修THA、因股骨颈骨折行THA或接受外侧化（偏移）股骨柄的患者。THA时的平均年龄为69±13岁[35 - 92岁]，其中85例男性（61%），55例女性（39%），平均体重指数为27kg/m²±11[16 - 39]。在最近一次随访时，32例患者（32髋）死亡，8例患者（8髋）随访时间不足3年，因此未纳入临床评估。收集Merle d'Aubigné（PMA）评分。采用Kaplan-Meier方法计算股骨柄生存率，将无菌性松动翻修以及因任何原因进行翻修或取出植入物作为终点。使用Cox模型分析翻修的危险因素。平均随访时间为10±3年[3 - 12年]。
术前PMA评分为12±2.6[5 - 17]，最后一次随访时为16±2.7[7 - 18]（P<0.00001）。在最后一次随访时记录到18例并发症（12.8%）。有15例早期并发症：6例脱位、5例股骨距骨折（4例采用钢丝环扎治疗，1例采用更换股骨柄加钢丝环扎治疗）、2例大转子骨折（非手术治疗）和2例坐骨神经麻痹。有3例晚期并发症：2例髂腰肌激惹和1例陶瓷内衬骨折。因无菌性松动进行手术翻修的股骨柄生存率为98%（95%CI：[0.96 - 1]）。在12年时，95%的股骨柄未进行翻修或取出（95%CI：[0.92 - 0.99]）。手术时年龄小于58岁是唯一与因任何原因进行股骨柄翻修显著相关的危险因素（P = 0.04）。
Corail™ 标准股骨柄的生存率与上一代股骨柄相似。该股骨柄所做的改进解决了颈部失效问题，且未引发新的并发症。
IV级（回顾性研究）。
