Complex Joint Reconstruction Center, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Int Orthop. 2019 Oct;43(10):2227-2233. doi: 10.1007/s00264-018-4220-4. Epub 2018 Nov 10.
Proximal femoral replacements (PFRs) have been recently utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical outcomes, complications, and survivorship of PFRs as a salvage treatment for severe bone loss after non-oncologic revision total hip arthroplasty.
This is a retrospective review of all patients who underwent femoral revision surgery using a single design PFR between 2004 and 2013 at our institution. Forty patients (41 hips) were included with a mean age of 64 years (29-90). According to Paprosky classification, 15 femurs had type IIIB defect, and 26 had type IV defect. Patients were followed for a mean of five years (2-10). The average length of reconstruction was 150 mm (81-261). A Kaplan-Meier analysis was used to determine the survival of the PFR.
A total of nine patients (9 PFRs, 22%) were re-operated upon. Three re-operations were for infection, two for dislocation, two for aseptic loosening, and two for periprosthetic fracture. The survivorship at five years was 95.1% for revision of the femoral stem for aseptic loosening. We did not find length of the segmental reconstruction or the indication for revision, to be a risk factor for implant failure or re-revision.
Proximal femoral replacements have shown an acceptable survivorship in non-oncologic revision hip arthroplasties for severe proximal femoral bone loss. The frequent use of constrained liners may decrease the risk of dislocation due to the loss of the abductor mechanism encountered in these complex reconstructions.
在复杂的翻修关节置换术中，近端股骨骨缺损时，最近采用了近端股骨置换术（PFR）。本研究的目的是评估 PFR 作为非肿瘤性全髋关节翻修术后严重骨丢失的挽救性治疗的临床结果、并发症和存活率。
这是对 2004 年至 2013 年期间在我院接受单一设计 PFR 股骨翻修手术的所有患者进行的回顾性研究。共纳入 40 例患者（41 髋），平均年龄 64 岁（29-90 岁）。根据 Paprosky 分类，15 个股骨有 IIIB 型缺损，26 个有 IV 型缺损。患者平均随访 5 年（2-10 年）。重建的平均长度为 150mm（81-261mm）。采用 Kaplan-Meier 分析评估 PFR 的存活率。
共有 9 例患者（9 个 PFR，22%）需要再次手术。3 次手术是因为感染，2 次是因为脱位，2 次是因为无菌性松动，2 次是因为假体周围骨折。股骨柄翻修因无菌性松动的 5 年存活率为 95.1%。我们没有发现节段重建的长度或翻修的适应证是植入物失败或再次翻修的危险因素。
在非肿瘤性髋关节翻修术中，对于严重的近端股骨骨丢失，近端股骨置换术显示出可接受的存活率。在这些复杂重建中，由于失去了外展肌机制，频繁使用约束衬垫可能会降低脱位的风险。
