Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital (M.M.I., D.S.P., C.M., B.M., and M.R.S.) and Institute of Medical Biometry and Informatics (T.B.), University of Heidelberg, Heidelberg, Germany.
Department of Orthopedics, Kepler University Hospital, Linz, Austria.
J Bone Joint Surg Am. 2019 Feb 6;101(3):265-269. doi: 10.2106/JBJS.18.00159.
Cementless stems demonstrate excellent long-term survival, but little is known about the long-term survival rate of the stem after isolated cup revision. The aim of the present retrospective cohort study was to determine the long-term survival rate of cementless stems retained after prior cup revision.
We reviewed the clinical and radiographic results of 119 total hip arthroplasties (THAs) utilizing a cementless, grit-blasted, tapered titanium femoral stem that were performed in 113 patients between January 1985 and December 1989. The mean age at the time of the primary THA was 52 years (range, 16 to 74 years) and the mean time between primary THA and cup revision was 13 years (standard deviation [SD], 6 years; range, 0 to 30 years). At the time of the latest follow-up, no patient was lost to follow-up, 36 patients representing 37 hips had died, and 11 hips in 11 patients had required stem revision. The mean follow-up was 13 years following cup revision (SD, 6 years; range, 0 to 28 years). A competing risk analysis was performed to estimate the survival of the stem after isolated cup revision, with death being the competing risk factor.
At 20 years after cup revision, the survival rate of retained stems was 89% (95% confidence interval [CI], 79% to 94%) for the end point of stem revision for any reason and 97% (95% CI, 91% to 99%) for the end point of stem revision for aseptic loosening.
The long-term survival of cementless stems retained after cup revision was excellent. Well-fixed cementless stems should be retained during cup revision for aseptic loosening.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
非骨水泥固定的股骨柄具有出色的长期生存率，但对于在初次髋关节置换术（THA）后进行单纯髋臼翻修时股骨柄的长期生存率知之甚少。本回顾性队列研究的目的是确定在初次 THA 后进行单纯髋臼翻修时保留的非骨水泥固定、喷砂酸蚀、锥形钛制股骨柄的长期生存率。
我们回顾了 1985 年 1 月至 1989 年 12 月期间 113 名患者的 119 例初次 THA 应用非骨水泥固定、喷砂酸蚀、锥形钛制股骨柄的临床和影像学结果。初次 THA 时的平均年龄为 52 岁（范围：16 岁至 74 岁），初次 THA 与髋臼翻修之间的平均时间为 13 年（标准差[SD]，6 年；范围：0 年至 30 年）。在末次随访时，无患者失访，36 名患者（37 髋）死亡，11 名患者（11 髋）需要进行股骨柄翻修。髋臼翻修后的平均随访时间为 13 年（SD，6 年；范围：0 年至 28 年）。采用竞争风险分析来估计单纯髋臼翻修后股骨柄的生存率，死亡是竞争风险因素。
髋臼翻修后 20 年，对于任何原因导致的股骨柄翻修的终点，保留的股骨柄的生存率为 89%（95%置信区间[CI]，79%至 94%），对于无菌性松动导致的股骨柄翻修的终点，生存率为 97%（95%CI，91%至 99%）。
髋臼翻修后保留的非骨水泥固定股骨柄具有优异的长期生存率。对于无菌性松动，在髋臼翻修时应保留固定良好的非骨水泥固定股骨柄。
IV 级。详见《作者须知》，以获取完整的证据等级描述。
