Khajuria Arun, Ward Jonathon, Cooper George, Stevenson Jonathon, Parry Michael, Jeys Lee
Royal Orthopaedic Hospital, Birmingham - UK.
Hip Int. 2018 Jan;28(1):68-73. doi: 10.5301/hipint.5000520.
Patients with failed hip arthroplasty requiring extensive femoral reconstruction often present with a multitude of comorbidities. Many treatment options limit initial mobilisation relying on bone graft incorporation. The use of endoprosthetic replacement (EPR), despite often being a "last resort", offers an expeditious solution with early mobilisation that is crucial in the comorbid individual. Many perceive that the surgical insult of EPR is associated with an increased mortality. The aim of this study was to report our experience of proximal femoral EPR as the treatment for failed arthroplasty or fracture fixation. Primary outcomes included mortality, complications, revision and function.
Retrospective review of proximal femoral EPR undertaken at our institution for non-oncological indications between 2007 and 2015 identified 37 patients with a mean follow-up of 33 months. Patient case notes, demographics and radiographs were studied.
The 90-day mortality following proximal femoral EPR was 2.7%. 9 patients had died at the time of final follow-up (mean time to death was 33 months). The mean preoperative and postoperative Oxford Hip Score improved from 8 to 31 respectively (p<0.05). When considering revision for any cause, 5-year survival was 94.6%. 2 patients suffered periprosthetic joint infection and 1 patient required revision for prosthesis dislocation.
We report a relatively low incidence of perioperative complications, with a mortality rate similar to other revision options in this high-risk cohort. Whilst further revision may not always be possible, this "last resort" technique is safe in the comorbid population presenting with significant proximal femoral bone deficiency.
髋关节置换失败且需要进行广泛股骨重建的患者通常伴有多种合并症。许多治疗方案因依赖骨移植融合而限制了早期活动。尽管使用内置假体置换（EPR）常常是“最后手段”，但它提供了一种能早期活动的快速解决方案，这对患有合并症的患者至关重要。许多人认为EPR的手术创伤与死亡率增加有关。本研究的目的是报告我们使用股骨近端EPR治疗置换失败或骨折固定的经验。主要结果包括死亡率、并发症、翻修和功能。
对2007年至2015年在我们机构进行的非肿瘤适应证的股骨近端EPR进行回顾性研究，确定了37例患者，平均随访33个月。研究了患者病历、人口统计学资料和X光片。
股骨近端EPR术后90天死亡率为2.7%。9例患者在最后随访时死亡（平均死亡时间为33个月）。术前和术后牛津髋关节评分平均分别从8分提高到31分（p<0.05）。考虑因任何原因进行翻修时，5年生存率为94.6%。2例患者发生假体周围关节感染，1例患者因假体脱位需要翻修。
我们报告围手术期并发症发生率相对较低，在这个高风险队列中死亡率与其他翻修方案相似。虽然可能并非总能进行进一步翻修，但这种“最后手段”技术对于存在严重股骨近端骨缺损的合并症患者是安全的。
