Mert Murat, Ermutlu Cenk, Kovalak Emrah, Ünkar Ethem, Okur Sibel Çağlar
İstanbul Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
İstanbul Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2019 Jan;53(1):19-23. doi: 10.1016/j.aott.2018.11.004. Epub 2018 Dec 21.
The aim of this study was to analyze the survivorship and clinical outcome of Cementless Spotorno (CLS) stem in young patients.
A total of 99 consecutive hip arthroplasties using CLS stem were performed on 84 patients younger than 50 years of age between 1993 and 2001. 63 patients were available for final follow-up (mean age: 39 ± 7.8 (range: 22-50)). Patients' Harris Hip Scores (HHS) and survivorship estimates were calculated. Radiographs were analyzed for acetabular implant status, canal fill index (CFI), stem alignment, osteolysis, and stress shielding.
Mean follow-up time was 18 years (13-3), and mean HHS was 88.7 (58-100). Patients with femoral neck fracture had a more favorable functional outcome (p = 0.027), while those with stems in varus had lower scores (p = 0.017). 31 stems (49%) were undersized and 30 hips (47%) had perifemoral osteolysis. Acetabular impairment was strongly associated with osteolysis in Gruen zones 1 and 7 (p < 0.01). Seventeen of the osteolytic lesions occurred in Gruen zone 1, 4 lesions in zone 2, 9 in zone 6 and 22 in zone 7. Forty nine stems were well aligned, 10 were in varus and 5 in valgus. Six patients presented with grade 1 stress shielding, 42 with grade 2, 9 with grade 3 and 7 with grade 4. Pedestal formation was evident in 13 cases. Kaplan-Meier survivorship estimates at 18 years with revision for any reason as the end point and with septic revisions excluded were 91.2% (95% CI: 83.7%-98.7%) and 95.1% (95% CI: 89.5%-100%), respectively. There was no difference between survival estimates of patients with different etiologies.
CLS stems in young patients have high survival estimates in the long term with good-excellent results. Spotorno stems perform equally well in all etiologies with no difference in terms of survivorship.
Level IV Therapeutic study.
本研究旨在分析年轻患者中使用非骨水泥型Spotorno（CLS）柄的生存率及临床结果。
1993年至2001年期间，对84例年龄小于50岁的患者连续进行了99例使用CLS柄的髋关节置换术。63例患者可供最终随访（平均年龄：39±7.8岁（范围：22 - 50岁））。计算患者的Harris髋关节评分（HHS）及生存率估计值。分析X线片以评估髋臼假体状况、髓腔填充指数（CFI）、柄的对线情况、骨溶解及应力遮挡。
平均随访时间为18年（13 - 3年），平均HHS为88.7分（58 - 100分）。股骨颈骨折患者的功能结果更佳（p = 0.027），而柄处于内翻位的患者评分较低（p = 0.017）。31个柄（49%）尺寸过小，30个髋关节（47%）出现股骨周围骨溶解。髋臼损害与Gruen 1区和7区的骨溶解密切相关（p < 0.01）。17处骨溶解病变发生在Gruen 1区，4处在2区，9处在6区，22处在7区。49个柄对线良好，10个处于内翻位，5个处于外翻位。6例患者出现1级应力遮挡，42例为2级，9例为3级，7例为4级。13例可见骨桥形成。以任何原因翻修为终点且排除感染性翻修的18年Kaplan - Meier生存率估计值分别为91.2%（95%可信区间：83.7% - 98.7%）和95.1%（95%可信区间：89.5% - 100%）。不同病因患者的生存率估计值无差异。
年轻患者使用CLS柄长期生存率高，结果优良。Spotorno柄在所有病因中表现相同，生存率无差异。
IV级治疗性研究。
Zotero 插件