Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Biomed J. 2018 Feb;41(1):46-51. doi: 10.1016/j.bj.2018.02.001. Epub 2018 Mar 30.
Femoral bone loss during revision total hip arthroplasty poses a challenging problem. Bypass fixation over the diaphysis has achieved clinical success in cases of proximal femoral bone loss. Fracture of cementless, fully bead-coated femoral stem is an uncommon complication. The purpose of this study is to analyze the patients with and without fracture stem and find out the possible risk factors.
From 2006 to 2012, a total of 251 revision long stems (Zimmer, Warsaw, IN) were implanted. In the same period, 17 broken stems that underwent treatment were included for analysis. Patients' demographic data, pattern of femoral bone loss, stem size, medial calcar support in the proximal region of the stem, and the timing of stem breakage were collected and analyzed.
The stem size in patients with a broken stem was smaller (p < 0.001), and medial calcar defect was 12.4% and 100% (p < 0.001), respectively. The bone defect was greater in broken group (p = 0.024). The mean duration between revision surgery and stem breakage was 58.07 ± 36.98 months. Smaller stem size, greater bone defect, and inadequate medial calcar bone support were major risk factors for stem breakage.
Bypass fixation in the distal diaphysis with a long stem prosthesis without adequate bone support over medial calcar area may cause stress concentration in the long stem and a fatigue fracture. Use of a smaller prosthesis is the major risk of stem broken. It is essential to repair the proximal femoral bone deficiency and implant selection for better metaphyseal engagement to prevent further stem complications.
Level III, case control study.
在翻修全髋关节置换术中，股骨骨丢失是一个具有挑战性的问题。在股骨近端骨丢失的情况下，骨干旁路固定已取得临床成功。非骨水泥、全珠涂层股骨柄骨折是一种罕见的并发症。本研究的目的是分析有无骨折柄的患者，并找出可能的危险因素。
2006 年至 2012 年，共植入 251 例翻修长柄（Zimmer，华沙，印第安纳州）。同期，对 17 例接受治疗的骨折柄进行了分析。收集并分析了患者的人口统计学数据、股骨骨丢失模式、柄大小、柄近端内侧骨嵴的支撑以及柄断裂的时间。
骨折组患者的柄尺寸较小（p<0.001），内侧骨嵴缺损分别为 12.4%和 100%（p<0.001）。骨折组的骨缺损更大（p=0.024）。翻修手术后至柄断裂的平均时间为 58.07±36.98 个月。较小的柄尺寸、较大的骨缺损和内侧骨嵴骨支撑不足是柄断裂的主要危险因素。
在无内侧骨嵴骨支撑的骨干下采用长柄假体进行旁路固定可能导致长柄内的应力集中和疲劳骨折。使用较小的假体是柄断裂的主要风险。修复股骨近端骨缺损和选择假体植入以更好地与骨干结合，以防止进一步的柄并发症是至关重要的。
三级，病例对照研究。
