Orthopaedic and Traumatologic Dept, Santo Spirito General Hospital, Rome, Italy.
Orthopaedic and Traumatologic Dept, Nuova Itor, Rome, Italy.
Int Orthop. 2019 Jan;43(1):63-70. doi: 10.1007/s00264-018-4233-z. Epub 2018 Nov 15.
In last three decades, total hip replacement in young patients became an habitual procedure. Principles of bone preservation are pushing many surgeons to implant conservative femoral components in patient younger than 65 years. Despite an overall good survivorship and clinical outcomes of conservative implants, failed cases are reported and the need to revise a conservative femoral component became an occasional procedure (with high prevalence of failed resurfacing implants).
During conservative femoral component revisions, we analyzed proximal bone stock preservation, considering the type of original component removed, aetiology of failure, timing of revision, and femoral explantation technique.
We identified four patterns of proximal femoral changes (types I-IV). We suggest, for each of them, a revision strategy directed toward a "conservative revision procedure" using conservative or primary component. Out of our 21 cases, none underwent further revision due to mechanical failure (follow-up ranging from 6 to 152 months, mean 54 months). We had two cases of re-operation: one for early septic loosening and one for prosthetic modular neck fracture.
If literature offers well-established guidelines to femoral revision of conventional stems, there is, on the other hand, a lack of data about revision strategies in presence of failed conservative implants. Although the mean follow-up of our procedures is still too short (4.5 years) to give final conclusions, we would leave a message: a conservative hip arthroplasty is not a "one time" opportunity for young and active people. A "conservative revision" is a valid option for at least a part of them, when an early failure of primary procedure occurred.
在过去的三十年中，全髋关节置换术在年轻患者中已成为常规手术。保骨原则促使许多外科医生在年龄小于 65 岁的患者中植入保守型股骨假体。尽管保守型假体的总体存活率和临床效果良好，但仍有失败病例报告，需要对保守型股骨假体进行翻修，这种情况并不少见（翻修失败的表面置换假体比例很高）。
在进行保守型股骨假体翻修时，我们分析了近端骨量的保存情况，考虑了原始假体的类型、失败的病因、翻修的时机以及股骨取出技术。
我们确定了近端股骨变化的四种模式（类型 I-IV）。对于每一种情况，我们建议采用“保守翻修策略”，使用保守或原假体进行翻修。在我们的 21 例病例中，没有一例因机械失败而进一步翻修（随访时间 6 至 152 个月，平均 54 个月）。我们有两例再手术病例：一例为早期感染性松动，一例为假体模块化颈骨折。
如果文献为常规股骨假体的翻修提供了明确的指导原则，那么在失败的保守型假体存在的情况下，翻修策略就缺乏数据支持。尽管我们的手术平均随访时间（4.5 年）还不足以得出最终结论，但我们想传达一个信息：对于年轻且活跃的人来说，保守型髋关节置换术并不是一次性的机会。当初次手术早期失败时，“保守翻修”是至少一部分患者的有效选择。
