Zampelis Vasileios, Flivik Gunnar, Kesteris Uldis
Department of Orthopaedics, Skåne University Hospital, Clinical Sciences, Lund University, Lund, Sweden.
Hip Int. 2020 Jul;30(4):417-422. doi: 10.1177/1120700019843123. Epub 2019 Apr 21.
In contrast to cemented hip prostheses, the effect of washing the bone bed with jet-lavage prior to insertion of cementless stem components in primary hip arthroplasty (THA) is unclear. Jet-lavage potentially decreases the risk of fat embolisation during rasping and stem insertion and might help in avoiding bacterial contamination. An earlier animal study has shown less debris and better-organised trabecular structure of new bone when jet-lavage was used. We hypothesised that the primary stability of cementless femoral stems implanted after jet-lavage of the femoral canal prior to stem insertion would improve with earlier stabilisation, as measured with Radiostereometry (RSA), compared with insertion without prior jet-lavage.
40 patients with primary osteoarthritis operated on with a cementless titanium grit blasted stem are included in the study. The patients were randomised to either jet-lavage or control without any lavage of the femoral canal prior to insertion of the prosthesis. The stem migration pattern was measured with RSA at 0, 3, 12, 24 and 72 months.
At 6 years, 19 patients remained for analysis in the jet-lavage and 18 in the control group. We found no difference in extent or pattern of migration as measured with RSA. Both groups seemed to have stabilised within 3 months after a slight subsidence and retroversion. No stem was revised or considered loose as measured with RSA.
Washing the bone bed with jet-lavage prior to insertion of cementless stems does not affect the stability of cementless femoral components. No adverse effects were observed.
与骨水泥型髋关节假体不同，在初次髋关节置换术（THA）中，于植入非骨水泥型柄部件前用喷射冲洗法冲洗骨床的效果尚不清楚。喷射冲洗有可能降低锉削和柄插入过程中脂肪栓塞的风险，并可能有助于避免细菌污染。一项较早的动物研究表明，使用喷射冲洗时，新骨中的碎片较少，小梁结构更有序。我们假设，与未事先进行喷射冲洗就植入柄相比，在柄插入前对股骨髓腔进行喷射冲洗后植入的非骨水泥型股骨干的初始稳定性会因更早实现稳定而得到改善，这通过放射立体测量法（RSA）来衡量。
本研究纳入了40例接受非骨水泥型喷砂钛柄手术的原发性骨关节炎患者。患者被随机分为两组，一组在假体植入前接受喷射冲洗，另一组作为对照组，不对股骨髓腔进行任何冲洗。在术后0、3、12、24和72个月时，用RSA测量柄的迁移模式。
6年后，喷射冲洗组有19例患者仍可供分析，对照组有18例。我们发现，用RSA测量时，两组在迁移程度或模式上没有差异。两组在轻微下沉和后倾后似乎在3个月内都已稳定。用RSA测量，没有柄需要翻修或被认为松动。
在植入非骨水泥型柄之前用喷射冲洗法冲洗骨床不会影响非骨水泥型股骨部件的稳定性。未观察到不良反应。
