Messamore William G, Vopat Matthew L G, Helsper Elizabeth A, Bachinskas Andrew J, Nentwig Michelle J, Bhargava Tarun
University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS.
Mid-America Orthopedics, Wichita, KS.
Kans J Med. 2020 Mar 20;13:51-55. eCollection 2020.
Direct anterior approach (DAA) total hip arthroplasty (THA) has become increasingly popular, largely due to utilization of a true internervous and intermuscular plane. However, recent literature has demonstrated an increased rate of femoral implant subsidence with this approach. Hence, different femoral implants, such as the tri-tapered femoral stem, have been developed to facilitate proper component insertion and positioning to prevent this femoral subsidence. The purpose of this study was to evaluate the subsidence rate of a tri-tapered femoral stem implanted utilizing a DAA, and to determine if the proximal femoral bone quality affects the rate of subsidence.
A retrospective analysis of 155 consecutive primary THAs performed by a single surgeon was conducted. Age, gender, primary diagnosis, and radiographic measurements of each subject were recorded. Radiological evaluations, such as bone quality, femoral canal fill, and implant subsidence, were measured on standardized anteroposterior (AP) and frog-leg lateral radiographs of the hip at 6-week and 6-month postoperative follow-up evaluations.
The average subsidence of femoral stems was 1.18 ± 0.8 mm. There was no statistical difference in the amount of subsidence based on diagnosis or proximal femora quality. The tri-tapered stem design consistently filled the proximal canal with an average of 91.9 ± 4.9% fill. Subsidence was not significantly associated with age, canal flare index (CFI), or experience of the surgeon.
THA utilizing the DAA with a tri-tapered femoral stem can achieve consistent and reliable fit regardless of proximal femoral bone quality.
直接前路（DAA）全髋关节置换术（THA）越来越受欢迎，这主要归功于其采用了真正的神经间和肌间平面。然而，最近的文献表明，采用这种方法时股骨植入物下沉率有所增加。因此，已开发出不同的股骨植入物，如三锥形股骨干，以促进部件的正确插入和定位，防止股骨下沉。本研究的目的是评估采用DAA植入的三锥形股骨干的下沉率，并确定股骨近端骨质量是否会影响下沉率。
对由一名外科医生连续进行的155例初次THA进行回顾性分析。记录每个受试者的年龄、性别、主要诊断和影像学测量数据。在术后6周和6个月的随访评估中，通过髋关节标准化前后位（AP）和蛙腿侧位X线片测量骨质量、股骨髓腔填充和植入物下沉等放射学评估指标。
股骨干的平均下沉为1.18±0.8毫米。基于诊断或股骨近端质量的下沉量没有统计学差异。三锥形柄设计始终能平均填充91.9±4.9%的近端髓腔。下沉与年龄、髓腔扩张指数（CFI）或外科医生的经验无显著相关性。
采用DAA和三锥形股骨干的THA无论股骨近端骨质量如何，都能实现一致且可靠的贴合。
