Laumonerie Pierre, Reina Nicolas, Gutierrez Claudia, Delclaux Stephanie, Tibbo Meagan E, Bonnevialle Nicolas, Mansat Pierre
Department of Orthopaedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France.
Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
Int Orthop. 2018 Jan;42(1):161-167. doi: 10.1007/s00264-017-3644-6. Epub 2017 Sep 21.
The most common reason for removal of well-fixed radial head prostheses is painful loosening. We hypothesised that short-stemmed prostheses, used for radial head arthroplasty, are not associated with an increased risk of implant loosening.
From 2002 to 2014, 65 patients were enrolled in a retrospective single-centre study. The radial head prostheses were classified as having either a long (30-mm) or short (16- to 22-mm) stem. The long-stemmed implants comprised 30 GUEPAR® DePuy Synthes (West Chester, PA, USA) and 20 Evolutive® Aston Medical (Saint-Etienne, France) devices; the short-stemmed implants comprised nine RECON and six STANDARD rHead® SBI-Stryker (Morrisville, PA, USA) devices. At last follow-up, clinical (range of motion, Disabilities of the Arm, Shoulder, and Hand score, Mayo Elbow Performance score) and radiographic (osteolysis) outcomes were assessed.
At a mean follow-up of 76.78 months (24-141), the rate of painful loosening [6 (40%) vs 8 (16%), p = 0.047] and osteolysis [12 (80%) vs 23 (46%), p = 0.02] were significantly higher in patients with short-stemmed versus long-stemmed implants. Despite the significant difference in loosening between stems as groups, individual stem length was not determined.
Tight-fitting implants with short stems are more prone to painful loosening.
取出固定良好的桡骨头假体的最常见原因是疼痛性松动。我们假设，用于桡骨头置换术的短柄假体与植入物松动风险增加无关。
2002年至2014年，65例患者纳入一项回顾性单中心研究。桡骨头假体分为长柄（30毫米）或短柄（16至22毫米）。长柄植入物包括30个GUEPAR®DePuy Synthes（美国宾夕法尼亚州韦斯特切斯特）和20个Evolutive®Aston Medical（法国圣艾蒂安）装置；短柄植入物包括9个RECON和6个STANDARD rHead®SBI-Stryker（美国宾夕法尼亚州莫里斯维尔）装置。在最后一次随访时，评估临床（活动范围、手臂、肩部和手部残疾评分、梅奥肘关节功能评分）和影像学（骨溶解）结果。
平均随访76.78个月（24至141个月），短柄植入物患者的疼痛性松动率[6例（40%）对8例（16%），p = 0.047]和骨溶解率[12例（80%）对23例（46%），p = 0.02]显著高于长柄植入物患者。尽管作为组的柄之间在松动方面存在显著差异，但未确定个体柄长度。
短柄的紧密贴合植入物更容易出现疼痛性松动。
