Department of Orthopaedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, New York, NY.
J Arthroplasty. 2019 Jul;34(7S):S292-S296. doi: 10.1016/j.arth.2019.03.007. Epub 2019 Mar 19.
Nonmodular and modular femoral stems have been associated with complications after revision total hip arthroplasty (rTHA). As such, the ideal femoral component for rTHA remains undecided. This study aims to report outcomes of titanium, tapered-fluted, modular and nonmodular femoral components in rTHA.
From January 1, 2013 to September 30, 2017, all rTHAs using modular or nonmodular femoral stems were identified. Demographic data including age, gender, and American Society of Anesthesiologists scores were collected. Surgical details including operative time and implant cost were also collected. Clinical outcomes including length of stay, dislocation, infection, fracture, reoperation, and re-revision were collected. Statistical analysis was performed using chi-square test and Student's t-test for all categorical and continuous variables, respectively.
One hundred forty-six rTHA cases (103 modular and 43 nonmodular) were identified with an average follow-up of 29 months (range 3-59 months). Nonmodular stems had a significantly lower cost when compared to modular implants (modular stems 120.8% higher cost; P < .001). The surgical time of nonmodular components was significantly greater (193 minutes vs 163 minutes; P = .029). There were no differences observed in any other surgical details or clinical outcomes assessed, including length of stay (P = .323), rate of re-revision of the femoral implant (P = .389), rate of re-operation (P = .383), and postop complications (P = .241), including infection (P = .095), dislocation (P = .778), and fracture (P = .959).
Nonmodular components provide encouraging clinical results with significantly lower costs compared to modular implants in rTHA. The use of titanium, tapered-fluted, nonmodular components may offer a more cost-effective approach to rTHA compared to their modular counterparts.
非模块化和模块化股骨柄在翻修全髋关节置换术后（rTHA）与并发症相关。因此，rTHA 的理想股骨组件仍未确定。本研究旨在报告 rTHA 中钛制、锥形槽、模块化和非模块化股骨组件的结果。
从 2013 年 1 月 1 日至 2017 年 9 月 30 日，确定了所有使用模块化或非模块化股骨柄的 rTHA。收集了包括年龄、性别和美国麻醉医师协会评分在内的人口统计学数据。还收集了手术细节，包括手术时间和植入物成本。收集了包括住院时间、脱位、感染、骨折、再次手术和再次翻修在内的临床结果。使用卡方检验和学生 t 检验分别对所有分类和连续变量进行统计学分析。
确定了 146 例 rTHA 病例（103 例为模块化，43 例为非模块化），平均随访 29 个月（范围 3-59 个月）。与模块化植入物相比，非模块化植入物的成本明显更低（模块化植入物成本高 120.8%；P<0.001）。非模块化组件的手术时间明显更长（193 分钟与 163 分钟；P=0.029）。在任何其他手术细节或临床结果评估中，包括住院时间（P=0.323）、股骨植入物再次翻修率（P=0.389）、再次手术率（P=0.383）和术后并发症（P=0.241），包括感染（P=0.095）、脱位（P=0.778）和骨折（P=0.959），均未观察到差异。
与模块化植入物相比，非模块化组件在 rTHA 中提供了令人鼓舞的临床结果，且成本显著降低。与模块化部件相比，使用钛制、锥形槽、非模块化部件可能为 rTHA 提供更具成本效益的方法。
