Vijayvargiya Mayank, Shetty Vivek, Makwana Kiran, Suri Harpreet Singh
Department of Orthopaedics, P.D. Hinduja National Hospital, Mumbai, India.
J Clin Orthop Trauma. 2019 Mar-Apr;10(2):368-373. doi: 10.1016/j.jcot.2018.02.001. Epub 2018 Feb 5.
CLS stem is commonly used today in primary hip arthroplasty, but only a few studies have evaluated their outcome in young high demanding patients. In Indian scenario, many patients require squatting and sitting cross-legged as part of their daily activities placing excessive load on the joint. We evaluated (I) Mid-long term functional and radiological results (II) Influence of age, gender, diagnosis, stem alignment, Canal fill index (CFI) on the outcome (III) Kaplan-Meier survivorship using revision for any reason or for aseptic loosening as an endpoint.
Retrospective evaluation of 64 THA in 54 patients operated between July 2000 to July 2011 using CLS stem was done. Mean follow-up was 10.3 years (5-14.9 years) with 5 patients lost to follow-up and 4 patients died. Mean age at surgery was 46.8 years (18-78 years).
Mean Harris hip score was 89.4 (72-100). Thigh pain was present in 4 hips which were not associated with the sizing of the stem (p = .489). Stable fixation by bony ingrowth was seen in 53 hips (96.4%) and by fibrous ingrowth in 2 cases (3.6%) with no case of loosening seen. Stress shielding was seen as Grade II in 17 hips (30.9%), Grade III in 3 hips (5.4%). Pedestal formation was seen in 9 hips (16.4%) which were statistically associated with varus alignment and CFI < 80. No stem revision was performed with stem survivorship of 100%.
The mid-term survival rates and good clinical-radiological outcomes of CLS stem in high demanding Indian population were excellent.
CLS 柄目前常用于初次髋关节置换术，但仅有少数研究评估了其在年轻高要求患者中的疗效。在印度的情况下，许多患者日常活动包括蹲坐和盘腿而坐，这会给关节带来过大负荷。我们评估了：（I）中长期功能和影像学结果；（II）年龄、性别、诊断、柄的对线、髓腔填充指数（CFI）对疗效的影响；（III）以任何原因翻修或无菌性松动作为终点的 Kaplan-Meier 生存率。
对 2000 年 7 月至 2011 年 7 月间使用 CLS 柄进行手术的 54 例患者的 64 例全髋关节置换术进行回顾性评估。平均随访 10.3 年（5 - 14.9 年），5 例失访，4 例死亡。手术时的平均年龄为 46.8 岁（18 - 78 岁）。
Harris 髋关节平均评分为 89.4（72 - 100）。4 例出现大腿疼痛，与柄的尺寸无关（p = 0.489）。53 例（96.4%）通过骨长入实现稳定固定，2 例（3.6%）通过纤维长入实现稳定固定，未见松动病例。17 例（30.9%）出现 II 级应力遮挡，3 例（5.4%）出现 III 级应力遮挡。9 例（16.4%）出现骨赘形成，与内翻对线和 CFI < 80 具有统计学相关性。未进行柄的翻修，柄的生存率为 100%。
CLS 柄在高要求的印度人群中的中期生存率和良好的临床影像学结果非常出色。
