Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Via Gramsci 14, 43126, Parma, PR, Italy.
Orthocenter for Hip and Knee Arthroplasty, Humanitas Research Hospital, Rozzano, Italy.
Int Orthop. 2020 Jan;44(1):61-68. doi: 10.1007/s00264-019-04335-9. Epub 2019 Apr 24.
The uncemented total hip arthroplasty (THA) has become the choice for many hip surgeons. Although conventional uncemented femoral components have a proven track record, there remain concerns about the rate of thigh pain, proximal stress shielding, and consequent loss of bone stock at revision surgery.
Inclusion criteria were the following: patients between 50 and 85 years old undergoing primary THA with implant of short (group 1) or conventional (group 2) femoral stem and with femoral shape type A, according to Dorr classification. Clinical follow-up was registered using OHS, HHS, and Womac scores. The radiographic scans were evaluated in order to compare component positioning and bone remodeling at five year follow-up.
We included in the analysis 60 subjects in group 1 and 67 in group 2. No differences were registered between the groups comparing demographic and operative data. One case in group 1 (1.7%) and three cases in group 2 (4.5%) reported an intra-operative fracture. There was a significant improvement in the functional scores in both groups with no significant difference at final follow-up. The incidence of reported thigh pain at follow-up was 14.9% in group 2 and 3.3% in group 1 (p = 0.033). Radiographic analysis documented a difference in terms of stress shielding and thinning of medial and lateral cortex in favour of group 1. Moreover, patients of group 1 showed a higher varus angle at six month follow-up.
In patients with high cortical index, a short stem shows better clinical and radiological outcomes at five year follow-up.
非骨水泥全髋关节置换术（THA）已成为许多髋关节外科医生的选择。虽然传统的非骨水泥股骨部件具有经过验证的良好记录，但仍存在一些问题，如大腿疼痛、近端应力遮挡以及随之而来的在翻修手术中骨量丢失的风险。
纳入标准为：50 至 85 岁的患者，行初次 THA 植入短型（组 1）或传统型（组 2）股骨柄，根据 Dorr 分类，股骨形态为 A 型。使用 OHS、HHS 和 Womac 评分记录临床随访情况。对影像学扫描进行评估，以比较 5 年随访时的组件定位和骨重塑情况。
我们纳入了 60 例组 1患者和 67 例组 2患者进行分析。两组患者在比较人口统计学和手术数据时没有差异。组 1中有 1 例（1.7%）和组 2中有 3 例（4.5%）报告术中骨折。两组患者的功能评分均有显著改善，最终随访时无显著差异。组 2中报告大腿疼痛的发生率为 14.9%，组 1为 3.3%（p=0.033）。影像学分析记录了在应力屏蔽和内外侧皮质变薄方面，组 1存在差异。此外，组 1患者在 6 个月随访时表现出更高的内翻角度。
在高皮质指数患者中，短柄在 5 年随访时具有更好的临床和影像学结果。
