Gold Peter, Garbarino Luke, Sodhi Nipun, Brown Levi, Stein Spencer, Jones Mark, Mont Michael A, Boraiah Sreevathsa
Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health New York, New York.
Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York.
Surg Technol Int. 2019 May 15;34:503-510.
The use of the direct anterior approach has been criticized as a significant risk factor for subsidence, perioperative fracture, and thigh pain. Therefore, the purpose of our study was to evaluate the outcome of using the center-center technique via the direct anterior approach.
Consecutive elective primary total hip arthroplasties performed using the center-center technique were retrospectively reviewed from May 2015 to February 2017. All cases were performed by a single surgeon at a high-volume, large academic center. The technique focuses on central alignment of the implant on both anteroposterior and lateral radiographs. Standardized objective radiographic measurements were taken at the first two-week follow-up visit to determine the fit and fill at the proximal and distal anatomic segments. Subsidence was measured by comparing the implant position at final follow up to the initial two-week postoperative visit. Other complications: intra- or postoperative fracture, infection, revision, and patient-reported thigh pain were further assessed. Functional postoperative outcomes were assessed using the Harris Hip Score (HHS).
A total of 138 patients with a mean age of 65 years and average follow up of 2.8 years were assessed. The mean postoperative HHS was 90 points (59-100). Mean implant subsidence was 1mm. A total of 90% (124) of implants had acceptable radiographic fit and fill in both proximal and distal segments. A majority 74% (102) of implants subsided less than 1mm, and 91% (126) subsided less than 2mm. One implant had radiographic subsidence of 9mm, which was treated with a shoe lift. There were no intraoperative fractures. One postoperative lateral cortex fracture three weeks after surgery due to mechanical fall was treated conservatively. No patients required revision arthroplasty for any reason or reported postoperative thigh pain.
The center-center technique can be used to consistently aid in proper femoral stem placement in both coronal and sagittal planes. Optimal fit and fill can be achieved safely using this technique.
直接前路手术的应用被批评为下沉、围手术期骨折和大腿疼痛的重要风险因素。因此，我们研究的目的是评估通过直接前路采用中心对中心技术的结果。
回顾性分析2015年5月至2017年2月连续采用中心对中心技术进行的择期初次全髋关节置换术。所有病例均由一位经验丰富的外科医生在一家大型学术中心完成。该技术注重在前后位和侧位X线片上使植入物中心对齐。在术后两周的首次随访时进行标准化的客观影像学测量，以确定近端和远端解剖节段的适配和填充情况。通过比较末次随访时与术后两周首次随访时的植入物位置来测量下沉情况。其他并发症：术中或术后骨折、感染、翻修以及患者报告的大腿疼痛也进行了进一步评估。术后功能结果采用Harris髋关节评分（HHS）进行评估。
共评估了138例患者，平均年龄65岁，平均随访2.8年。术后HHS平均为90分（59 - 100分）。平均植入物下沉1mm。共有90%（124例）的植入物在近端和远端节段的影像学适配和填充情况良好。大多数74%（102例）的植入物下沉小于1mm，91%（126例）下沉小于2mm。一枚植入物影像学下沉9mm，采用鞋垫进行治疗。无术中骨折。术后三周因机械性跌倒出现一例外侧皮质骨折，采用保守治疗。无患者因任何原因需要进行翻修手术，也无患者报告术后大腿疼痛。
中心对中心技术可始终如一地辅助股骨柄在冠状面和矢状面正确放置。使用该技术可安全实现最佳适配和填充。
