Rivière Charles, Grappiolo Guido, Engh Charles A, Vidalain Jean-Pierre, Chen Antonia-F, Boehler Nicolas, Matta Jihad, Vendittoli Pascal-André
MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Centre, UK.
Unit of Hip Diseases and Joint Replacement Surgery, Humanitas Clinical and Research Center, Italy.
EFORT Open Rev. 2018 Feb 26;3(2):45-57. doi: 10.1302/2058-5241.3.170024. eCollection 2018 Feb.
Bone remodelling around a stem is an unavoidable long-term physiological process highly related to implant design. For some predisposed patients, it can lead to periprosthetic bone loss secondary to severe stress-shielding, which is thought to be detrimental by contributing to late loosening, late periprosthetic fracture, and thus rendering revision surgery more complicated.However, these concerns remain theoretical, since late loosening has yet to be documented among bone ingrowth cementless stems demonstrating periprosthetic bone loss associated with stress-shielding.Because none of the stems replicate the physiological load pattern on the proximal femur, each stem design is associated with a specific load pattern leading to specific adaptive periprosthetic bone remodelling. In their daily practice, orthopaedic surgeons need to differentiate physiological long-term bone remodelling patterns from pathological conditions such as loosening, sepsis or osteolysis.To aid in that process, we decided to clarify the behaviour of the five most used femoral stems. In order to provide translational knowledge, we decided to gather the designers' and experts' knowledge and experience related to the design rationale and the long-term bone remodelling of the following femoral stems we deemed 'legendary' and still commonly used: Corail (Depuy); Taperloc (Biomet); AML (Depuy); Alloclassic (Zimmer); and CLS-Spotorno (Zimmer). Cite this article: 2018;3:45-57. DOI: 10.1302/2058-5241.3.170024.
柄周围的骨重塑是一个不可避免的长期生理过程，与植入物设计高度相关。对于一些易感患者，它可能导致继发于严重应力遮挡的假体周围骨丢失，人们认为这是有害的，因为它会导致晚期松动、晚期假体周围骨折，从而使翻修手术更加复杂。然而，这些担忧仍然只是理论上的，因为在显示与应力遮挡相关的假体周围骨丢失的骨长入非骨水泥柄中，尚未有晚期松动的记录。由于没有一个柄能复制股骨近端的生理负荷模式，每种柄设计都与特定的负荷模式相关，从而导致特定的适应性假体周围骨重塑。在日常实践中，骨科医生需要区分生理性长期骨重塑模式与诸如松动、感染或骨溶解等病理状况。为了帮助这一过程，我们决定阐明五种最常用的股骨柄的行为。为了提供转化知识，我们决定收集与以下我们认为“具有传奇色彩”且仍常用的股骨柄的设计原理和长期骨重塑相关的设计者和专家的知识与经验：Corail（Depuy公司）；Taperloc（Biomet公司）；AML（Depuy公司）；Alloclassic（Zimmer公司）；以及CLS-Spotorno（Zimmer公司）。引用本文：2018；3：45 - 57。DOI：10.1302/2058 - 5241.3.170024。
