Apostu Dragos, Lucaciu Ondine, Berce Cristian, Lucaciu Dan, Cosma Dan
1 Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
2 Department of Oral Rehabilitation, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
J Int Med Res. 2018 Jun;46(6):2104-2119. doi: 10.1177/0300060517732697. Epub 2017 Nov 3.
Hip osteoarthritis is the most common joint disorder, and is represented by a degenerative process, resulting in pain and functional impairment. If conservative treatment for hip osteoarthritis fails, the only remaining option is hip arthroplasty. Despite good survival of implants, loosening of components is the most common complication. This leads to revision surgeries, which are technically demanding, expensive, and result in a low satisfaction rate. Uncemented hip replacements require proper osseointegration for increased survival. Physical characteristics of implants include biocompatibility, Young's modulus of elasticity, strength, and corrosion resistance, and each influence fixation of implants. Moreover, implant surface treatments, pore size, pore density, and femoral stem design should be appropriately selected. Patients' optimization of obesity, osteoporosis, cardiovascular disease, psychotic disorders, and smoking cessation are associated with a higher survival of implants. Surgical factors, such as approach, drilling and rasping, acetabular bone coverage, acetabular cup positioning, and implant size, also affect survival of implants. Avoiding drugs, which may impair osseointegration of implants, and having an appropriate rehabilitation protocol are important. Future directions include anabolic and anti-catabolic bone-acting drugs to enhance osseointegration of implants. Comprehensive knowledge of the factors mentioned above is important for preventing aseptic loosening, with important socioeconomic consequences.
髋关节骨关节炎是最常见的关节疾病，表现为一种退行性过程，导致疼痛和功能障碍。如果髋关节骨关节炎的保守治疗失败，唯一剩下的选择就是髋关节置换术。尽管植入物的生存率较高，但部件松动是最常见的并发症。这会导致翻修手术，翻修手术技术要求高、费用昂贵，且满意度较低。非骨水泥型髋关节置换需要适当的骨整合以提高生存率。植入物的物理特性包括生物相容性、杨氏弹性模量、强度和耐腐蚀性，每一项都会影响植入物的固定。此外，应适当选择植入物表面处理、孔径、孔隙密度和股骨柄设计。患者对肥胖、骨质疏松症、心血管疾病、精神障碍的优化以及戒烟与植入物更高的生存率相关。手术因素，如手术入路、钻孔和锉削、髋臼骨覆盖、髋臼杯定位和植入物尺寸，也会影响植入物的生存率。避免使用可能损害植入物骨整合的药物以及制定适当的康复方案很重要。未来的方向包括使用促进合成代谢和抗分解代谢的骨活性药物来增强植入物的骨整合。全面了解上述因素对于预防无菌性松动很重要，这具有重要的社会经济影响。
