Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan.
J Arthroplasty. 2020 Mar;35(3):811-817. doi: 10.1016/j.arth.2019.10.018. Epub 2019 Oct 14.
Modular stems are useful for total hip arthroplasty (THA) in anatomically difficult dysplasia. Here, we present mean 6.8-year outcomes of cementless primary THA using S-ROM-A (modified modular stem for Asian patients) femoral prosthesis in anatomically difficult cases.
Charts of 373 patients (461 hips) undergoing THA (mean age, 58 years) were reviewed for clinical evaluation of modified Merle d'Aubigné-Postel score and Kaplan-Meier survivorship with revision for any reason as the end point. For radiographic analysis, 331 patients (412 hips) followed up for ≥5 years were included. Bearing couples were metal-on-metal (n = 145), metal-on-polyethylene (n = 120), and ceramic-on-polyethylene (n = 147). Radiography and multiplanar computed tomography were performed.
No postoperative dislocation or deep infection occurred. Mean modified Merle d'Aubigné-Postel score improved significantly (10.9 points preoperatively, 16.7 points at last follow-up; P < .001). Cumulative 5- and 10-year stem survival rates were 100% and 84%, respectively (95% confidence interval, 75%-93%). All stems were classified as bone ingrown fixation. Osteolysis occurred in metal-on-metal (42.8%) and metal-on-polyethylene (15.8%) groups. Mean time to osteolysis was ~3 years, with no significant difference between 3 groups (P = .264). In logistic regression, lower cup inclination angle was significantly associated with osteolysis (odds ratio, 0.914; 95% confidence interval, 0.84-0.99; P = .029).
S-ROM-A femoral prosthesis achieved excellent midterm fixation, and the modular system was useful in primary THA with severe deformity. Bearing couples are potentially associated with adverse reactions to metal debris. S-ROM-A with ceramic-on-polyethylene bearing couples may be an option for anatomically difficult THA.
在解剖困难的发育不良中，模块化柄对于全髋关节置换术（THA）非常有用。在这里，我们介绍了使用 S-ROM-A（为亚洲患者设计的改良模块化柄）股骨假体进行解剖困难病例初次非骨水泥 THA 的平均 6.8 年结果。
回顾了 373 例（461 髋）接受 THA（平均年龄 58 岁）的患者的图表，以评估改良 Merle d'Aubigné-Postel 评分的临床结果，并以任何原因的翻修为终点进行 Kaplan-Meier 生存率分析。对于放射学分析，纳入了随访时间≥5 年的 331 例（412 髋）患者。轴承组件为金属对金属（n=145）、金属对聚乙烯（n=120）和陶瓷对聚乙烯（n=147）。进行了放射摄影和多平面计算机断层扫描。
术后无脱位或深部感染。改良 Merle d'Aubigné-Postel 评分显著提高（术前 10.9 分，末次随访 16.7 分；P<0.001）。5 年和 10 年的累计生存率分别为 100%和 84%（95%置信区间，75%-93%）。所有柄均被归类为骨长入固定。金属对金属（42.8%）和金属对聚乙烯（15.8%）组均发生骨溶解。骨溶解的平均时间约为 3 年，3 组之间无显著差异（P=0.264）。在逻辑回归中，髋臼杯倾斜角度较低与骨溶解显著相关（比值比，0.914；95%置信区间，0.84-0.99；P=0.029）。
S-ROM-A 股骨假体获得了优异的中期固定效果，模块化系统在严重畸形的初次 THA 中非常有用。轴承组件可能与金属碎屑的不良反应有关。对于解剖困难的 THA，S-ROM-A 与陶瓷对聚乙烯轴承组件可能是一种选择。
