Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.
Int Orthop. 2020 Sep;44(9):1685-1691. doi: 10.1007/s00264-020-04582-1. Epub 2020 May 13.
To determine clinical and radiographic risk factors for the vertical subsidence of modular fluted tapered stems implanted using the transfemoral Wagner approach in a cohort of revision hip arthroplasties.
A retrospective review of a single-centre surgical registry was performed. Patients who underwent a revision total hip arthroplasty, in which the uncemented modular fluted tapered stem (REVISION Hip/Anca-Ti6Al4V, LimaCorporate, Udine, Italy) was implanted using the transfemoral Wagner approach, were identified. Patient's demographic data, clinical and radiographic outcomes and post-operative complications were assessed. As a significant subsidence, a 5-mm cut-off was chosen.
We identified 278 revision hip arthroplasties with a mean follow-up of 35 months. The median of subsidence in the group of 5 mm and less was 2 mm, and 17 mm in the group of subsidence of 5 mm and more. A negative correlation was found between the stem subsidence and the length of good contact between the medial and lateral cortical bone and the stem (medial, - 0.248; P < 0.001, lateral, 0.284; P < 0.001). For 200 mm stems, the percentage of good contact between femoral parts of stem and bone on medial side was 40.5% (81.0 mm) for patients with subsidence of five or less mm, and 30% (60.0 mm) for lateral side. For 140 mm stems, the percentage was 52.86% (74.0 mm) for medial side and 40.36% (56.5 mm) for lateral side. A neck length was shown to correlate significantly with the stem subsidence (P = 0.004).
It is crucial to provide good contact between the bilateral cortical bone and stem, and, if possible, to select implant constructs with shorter femoral necks, in order to reduce subsidence and to ensure longer implant survivorship.
在接受经股骨干 Wagner 入路翻修全髋关节置换术的患者队列中，确定使用模块化开槽锥形股骨柄的临床和影像学垂直下沉的危险因素。
对单中心手术数据库进行回顾性研究。确定接受非骨水泥模块化开槽锥形股骨柄（REVISION Hip/Anca-Ti6Al4V，LimaCorporate，Udine，意大利）经股骨干 Wagner 入路翻修全髋关节置换术的患者。评估患者的人口统计学数据、临床和影像学结果以及术后并发症。选择 5mm 作为明显下沉的截断值。
我们共纳入 278 例翻修髋关节，平均随访 35 个月。下沉 5mm 及以下组的中位数为 2mm，下沉 5mm 及以上组的中位数为 17mm。发现股骨柄下沉与内侧和外侧皮质骨与股骨柄之间的良好接触长度呈负相关（内侧，-0.248；P<0.001，外侧，0.284；P<0.001）。对于 200mm 长的股骨柄，下沉 5mm 及以下组患者的股骨柄与骨之间的内侧接触率为 40.5%（81.0mm），外侧接触率为 30%（60.0mm）。对于 140mm 长的股骨柄，内侧接触率为 52.86%（74.0mm），外侧接触率为 40.36%（56.5mm）。股骨柄颈长度与股骨柄下沉显著相关（P=0.004）。
为了减少下沉并确保更长的植入物存活率，重要的是要提供双侧皮质骨与股骨柄之间的良好接触，如果可能的话，还应选择股骨柄颈较短的植入物结构。
