Oxford Foundation School, Oxford, UK.
Royal Orthopaedic Hospital, Birmingham, UK.
Hip Int. 2021 May;31(3):295-303. doi: 10.1177/1120700020916870. Epub 2020 Apr 16.
Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA).
A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable.
920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with >5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9.
At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure.
使用模块化颈假体可使股骨颈版本、偏移和长度更具可变性。据报道，这些假体的翻修率更高。本研究的目的是评估原发性全髋关节置换术（THA）中钛钛合金模块化颈假体的总体和特定原因的翻修率。
按照 PRISMA 指南进行系统评价，并利用多个数据库。所有结果均进行了筛选，以确定其是否符合入选标准。纳入了 2000 年以后发表的、使用当前一代钛钛合金模块化颈假体的研究。在适用的情况下，分析了总体和特定原因的翻修率，并与固定颈假体进行了比较。
筛选了 920 项研究。应用排除标准后，对 23 项研究进行了全面评估，其中 14 项研究被纳入。这些研究包括 12 项病例系列研究和 2 项关节登记分析。21841 例患者接受了模块化颈假体治疗，加权平均随访时间为 5.7 年，平均年龄为 62.4 岁，平均体重指数（BMI）为 28.4kg/m。模块化颈假体和固定颈假体的总体翻修率分别为 3.95%和 2.98%。对于随访时间超过 5 年的研究，平均翻修率为 3.08%。不同假体设计的特定原因翻修率无差异。Harris 髋关节评分的平均改善为 41.9。
在中期，钛钛合金原发性模块化颈 THA 的翻修率是可以接受的。对于存在严重解剖学髋关节畸形、无法通过标准固定颈假体矫正的患者，这些假体是一种合理的治疗选择。男性患者、高 BMI 以及需要颈、偏移或头较大的假体的患者，假体失败的风险更高。
