Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392, Giessen, Germany.
Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstraße 33, 35392, Giessen, Germany.
Arch Orthop Trauma Surg. 2020 Feb;140(2):247-253. doi: 10.1007/s00402-019-03315-3. Epub 2019 Nov 30.
Stress shielding may lead to aseptic loosening which is a common reason for implant failure. An established method to identify implants with risk of implant failure caused by aseptic loosening is to measure early migration of the stem with the "Ein Bild Roentgen Analyse" femoral component analysis (EBRA-FCA). Therefore, the aim of this study was to measure the migration of a cementless short stem prosthesis via EBRA-FCA to predict the future performance.
A total collective of 71 patients were treated with a cementless short hip stem prosthesis. Indications for surgery were primary coxarthrosis, dysplasia coxarthrosis or femoral head necrosis. After surgery, the patients were followed-up immediately after 3, 6, 12, 24, 36, and 48 months and X-ray images for EBRA-FCA measurements were taken. Axial caudal migration as well as the varus/valgus tilting of the prosthesis was determined. Possible influencing factors like BMI, age, diagnosis, gender or Harris Hip Score (HHS) on the migration of the stem were assessed.
HHS increased significantly direct postoperatively (p < 0.001). At the second follow-up the average caudal migration was 0.42 ± 0.52 mm (range: 0.00-2.85 mm) (p < 0.001). A total of 14 patients underwent a caudal migration greater than 1.5 mm until 48 months. The initial varus and valgus tilts within the first 3 months were significant (p < 0.001). No correlations between BMI, age, diagnosis, gender or HHS and the migration as well as the tilting of the cementless short hip stem prosthesis were found.
Although initial axial caudal migration as well as tilting tendencies in varus or valgus position can be detected, there is no marked migration of the examined prosthesis after the first 48 months. Likewise, no aseptic early loosening was detected throughout the study period, which indicates good osseointegration of the short stem prosthesis.
应力遮挡可能导致无菌性松动，这是植入物失败的常见原因。一种确定因无菌性松动导致植入物失败风险的方法是使用“Ein Bild Roentgen Analyse”股骨部件分析（EBRA-FCA）来测量柄的早期迁移。因此，本研究的目的是通过 EBRA-FCA 测量无水泥短柄假体的迁移，以预测未来的性能。
总共 71 例患者接受了无水泥短柄髋关节假体治疗。手术指征为原发性髋关节骨关节炎、发育性髋关节骨关节炎或股骨头坏死。手术后，患者在术后 3、6、12、24、36 和 48 个月时立即进行随访，并进行 EBRA-FCA 测量的 X 射线图像拍摄。确定假体的轴向尾向迁移以及内翻/外翻倾斜。评估 BMI、年龄、诊断、性别或 Harris 髋关节评分（HHS）等可能影响因素对柄迁移的影响。
HHS 术后显著增加（p<0.001）。第二次随访时，平均尾向迁移为 0.42±0.52mm（范围：0.00-2.85mm）（p<0.001）。共有 14 例患者在 48 个月内发生了大于 1.5mm 的尾向迁移。前 3 个月内的初始内翻和外翻倾斜是显著的（p<0.001）。未发现 BMI、年龄、诊断、性别或 HHS 与无水泥短髋关节假体的迁移和倾斜之间存在相关性。
尽管可以检测到初始轴向尾向迁移以及内翻或外翻位置的倾斜趋势，但在最初的 48 个月后，检查的假体没有明显的迁移。同样，在整个研究期间未发现无菌性早期松动，这表明短柄假体具有良好的骨整合。
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