CNRS, SIGMA Clermont, ICCF, Université Clermont Auvergne, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
Orthopedic and Trauma Surgery Department, Hôpital Gabriel Montpied, CHU de Clermont Ferrand, BP 69, 63003, Clermont-Ferrand, France.
Eur J Orthop Surg Traumatol. 2020 Jul;30(5):845-850. doi: 10.1007/s00590-020-02644-z. Epub 2020 Feb 27.
Results of total hip replacement (THR) for aseptic osteonecrosis are controversial and conflicting according to implant type and generation. The present study consisted in a retrospective assessment of implant survival in primary THR for aseptic osteonecrosis, using a cemented stem, standard polyethylene press-fit acetabular component, and metal-metal bearing. The study hypothesis was that THR results are equivalent between aseptic osteonecrosis and osteoarthritis of the hip.
A single-center retrospective study included 54 patients with metal-on-metal THR for femoral head osteonecrosis. The main endpoint was revision surgery for all causes, whether implant related or procedure related; secondary endpoints were complications and progression in clinical scores.
Mean follow-up was 13.9 ± 1.6 years (range 12.0-17.1 years). Eighteen of the 54 patients (33.3%) died. Implant survival at last follow-up was 93.8% (95% CI, 87.1-100). There were 12 complications (22.2%): 1 intraoperative, 5 (9.3%) immediate postoperative, and 6 (11.1%) long term. Clinical assessment found a significant 43.1 point improvement in mean Harris score (p = 8.4E-33) and a 5.6 point improvement in mean PMA score (p = 2.9E-22).
Survival in primary THR for aseptic osteonecrosis was good. Follow-up needs to be rigorous to screen for onset of complications. Primary THR is thus justified in Ficat-Arlet stage 3 and 4 aseptic osteonecrosis of the hip.
IV.
根据植入物类型和代际的不同，全髋关节置换术（THR）治疗无菌性骨坏死的结果存在争议和矛盾。本研究回顾性评估了使用骨水泥固定柄、标准聚乙烯压配髋臼组件和金属-金属轴承的初次 THR 治疗无菌性骨坏死的植入物存活率。研究假设是 THR 的结果在无菌性骨坏死和髋关节骨关节炎之间是等效的。
单中心回顾性研究纳入了 54 例因股骨头无菌性坏死行金属对金属 THR 的患者。主要终点是所有原因的翻修手术，包括与植入物相关或与手术相关的翻修手术；次要终点是并发症和临床评分的进展。
平均随访时间为 13.9±1.6 年（范围 12.0-17.1 年）。54 例患者中有 18 例（33.3%）死亡。末次随访时的植入物存活率为 93.8%（95%CI，87.1-100）。有 12 例并发症（22.2%）：术中 1 例，术后即刻 5 例（9.3%），术后长期 6 例（11.1%）。临床评估发现平均 Harris 评分显著改善 43.1 分（p=8.4E-33），平均 PMA 评分改善 5.6 分（p=2.9E-22）。
初次 THR 治疗无菌性骨坏死的存活率良好。需要进行严格的随访以筛查并发症的发生。因此，在 Ficat-Arlet 分期 3 和 4 的无菌性股骨头坏死中，初次 THR 是合理的。
IV。
