Wacha H, Domsel G, Herrmann E
Department of Surgery, Hospital zum Heiligen Geist, Academic Hospital of the Goethe University, Frankfurt am Main, Germany.
Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt/M, Frankfurt am Main, Germany.
Eur J Trauma Emerg Surg. 2018 Jun;44(3):457-469. doi: 10.1007/s00068-017-0895-2. Epub 2018 Jan 17.
An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013.
A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen-Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint.
Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies.
The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision.
德国最近建立了一个关节成形术登记处，但大多数短柄创新技术的长期结果尚缺。短柄髋关节置换术通常适用于年轻、活动量大的患者。我们将适应证扩大到了老年人群、股骨颈骨折（FNF）和发育异常患者。我们评估了2003年至2013年期间在该人群中使用保留股骨颈柄（CFP）进行的所有全髋关节置换术（THA）。
对连续的1217例平均年龄68.7岁的CFP-THA患者进行回顾性随访，中位随访时间为4.8年（患者随访四分位间距为3.0至6.9年）。我们在之前两项研究中使用的一份问卷由89.15%的患者作答，问卷包含有关主诉、满意度、再次手术和脱位的信息。1217例患者中，77例死亡。采用竞争风险方法，根据Aalen-Johanson估计量评估柄和臼杯的生存率，将因感染性或无菌性松动或死亡进行翻修作为竞争终点。
在回答问卷的患者中，92.5%没有与手术相关的主诉。在全部1217例患者中，有43例进行了翻修（4.2%），情况如下：因柄的无菌性松动进行柄和臼杯翻修（n = 10）、感染（n = 6）、疼痛（n = 4）或创伤（n = 3）；因无菌性松动进行臼杯翻修（n = 3）、脱位（n = 5）以及进行偏心距翻修（n = 12）。术后9年柄的生存率为96% , 臼杯的生存率为99%。统计分析证实，年龄较小（p = 0.033）、男性（p = 0.040）、发育异常（p = 0.032）以及柄尺寸过小或过大的患者进行柄翻修的风险较高（p = 0.001），女性进行臼杯翻修的风险较高（p = 0.036）。股骨颈骨折（p > 0.20）和年龄≥80岁（p = 0.114）患者的柄松动风险没有更高。我们的数据还与当前文献进行了比较，特别是与现有的CFP研究进行了比较。
随访9年后CFP柄的生存率高达96%，与之前发表的长期生存率相比情况良好。80岁及以上患者和股骨颈骨折患者的翻修风险没有更高。CFP保留设计在罕见的翻修病例中也允许使用标准柄。
