Department of Joint Surgery, Institute of Orthopedics, 940th Hospital of PLA Joint Logistics Support Force, Lanzhou, 730050, China.
Department of Geriatrics Center, Xijing Hospital of Air Force Military Medical University, Xi'an, 710032, China.
J Orthop Surg Res. 2019 Aug 29;14(1):282. doi: 10.1186/s13018-019-1336-1.
Severe anatomical abnormalities exist in proximal femoral deformities (PFDs). Total hip arthroplasty (THA) is associated with drawbacks such as high surgical complexity, long operation time, requirement for high surgical skills, high incidences of postoperative complications, and poor efficacy.
This study aimed to investigate the short-term efficacy of THA with femoral osteotomy and modular prosthesis implantation for femoral fixation and reconstruction in patients with PFD.
A total of 15 patients (15 hips) with rotational PFD treated with THA with femoral osteotomy and modular prosthesis between August 2012 and September 2014 were included. There were 10 male (10 hips) and 5 female (5 hips) patients. Preoperative limb shortening, intraoperative osteotomy length, and postoperative limb length were recorded. The Harris hip score was adopted for assessing the clinical results. Postoperative radiography was performed to observe the prosthesis position, as well as the presence or absence of abnormalities such as osteolysis, loosening, and subsidence of the prosthesis.
All 15 patients were followed up postoperatively, with a mean follow-up duration of 62.5 (range 20-85) months. The postoperative limb-length discrepancy (1.0 ± 0.5 cm) was significantly less than the preoperative discrepancy (3.2 ± 1.2 cm) (t = - 2.501, P = 0.002). The Harris hip score significantly improved from a mean of 47.2 ± 9.9 points preoperatively to 89.7 ± 3.9 points during the last follow-up visit (t = 21.31, P = 0.001). Immediate postoperative radiographs showed restoration of limb alignment after femoral osteotomy, excellent initial press-fit fixation of the S-ROM prosthesis, and good canal filling. According to Engh's criteria, all 15 hips were graded as ingrown bones. No infection, prosthesis loosening, periprosthetic fracture, or other complications occurred.
In patients with femoral deformities treated with THA, precise osteotomy, good coaptation of the osteotomy surfaces, and correct choice of modular S-ROM prostheses for femoral reconstruction and fixation remain the key factors for surgical success.
股骨近端畸形（PFD）存在严重的解剖学异常。全髋关节置换术（THA）存在手术复杂、手术时间长、对手术技术要求高、术后并发症发生率高和疗效差等缺点。
本研究旨在探讨股骨截骨和模块假体植入 THA 治疗 PFD 患者股骨固定和重建的短期疗效。
2012 年 8 月至 2014 年 9 月，采用股骨截骨和模块假体植入 THA 治疗 15 例（15 髋）旋转性 PFD 患者。其中男 10 例（10 髋），女 5 例（5 髋）。记录术前肢体短缩、术中截骨长度和术后肢体长度。采用 Harris 髋关节评分评估临床结果。术后行影像学检查观察假体位置及假体松动、骨溶解、下沉等异常。
所有患者术后均获得随访，随访时间平均 62.5（20-85）个月。术后肢体长度差异（1.0±0.5cm）明显小于术前（3.2±1.2cm）（t=-2.501，P=0.002）。Harris 髋关节评分由术前的 47.2±9.9 分显著提高至末次随访时的 89.7±3.9 分（t=21.31，P=0.001）。术后即刻 X 线片显示股骨截骨后肢体对线恢复良好，S-ROM 假体初始压配固定良好，髓腔充盈良好。根据 Engh 标准，所有 15 髋均为骨长入。无感染、假体松动、假体周围骨折等并发症发生。
THA 治疗股骨畸形患者时，精确截骨、良好的截骨面贴合以及正确选择模块化 S-ROM 假体进行股骨重建和固定仍然是手术成功的关键因素。
