Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom.
Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
J Bone Joint Surg Am. 2020 Sep 16;102(18):1600-1608. doi: 10.2106/JBJS.19.01242.
Total hip replacement (THR) with a cemented polished taper-slip (PTS) femoral stem has excellent long-term results but is associated with a higher postoperative periprosthetic femoral fracture (PFF) risk compared with composite beam stems. This study aimed to identify risk factors associated with PFF revision following THR with PTS stems.
In a retrospective cohort study, 299,019 primary THRs using PTS stems from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) were included, with a median follow-up of 5.2 years (interquartile range [IQR], 3.1 to 8.2 years). The adjusted hazard ratio (HR) of PFF revision was estimated for each variable using multivariable Cox survival regression analysis.
Of 299,019 THR cases, 1,055 underwent revision for PFF at a median time of 3.1 years (IQR, 1.0 to 6.1 years). The mean age (and standard deviation) was 72 ± 9.7 years, 64.3% (192,365 patients) were female, and 82.6% (247,126 patients) had an American Society of Anesthesiologists (ASA) class of 1 or 2. Variables associated with increased PFF were increasing age (HR, 1.02 per year), intraoperative fracture (HR, 2.57 [95% confidence interval (CI), 1.42 to 4.66]), ovaloid (HR, 1.96 [95% CI, 1.22 to 3.16]) and round cross-sectional shapes (HR, 9.58 [95% CI, 2.29 to 40.12]), increasing stem offset (HR, 1.07 per millimeter), increasing head size (HR, 1.04 per millimeter), THR performed from 2012 to 2016 (HR, 1.45 [95% CI, 1.18 to 1.78]), cobalt-chromium stem material (HR, 6.7 [95% CI, 3.0 to 15.4]), and cobalt-chromium stems with low-viscosity cement (HR, 22.88 [95% CI, 9.90 to 52.85]). Variables associated with a decreased risk of PFF revision were female sex (HR, 0.52 [95% CI, 0.45 to 0.59]), increasing stem length (HR, 0.97 per millimeter), and a ceramic-on-polyethylene bearing (HR, 0.55 [95% CI, 0.36 to 0.85]).
Increased risk of PFF revision was associated with PTS stems that are short, have high offset, are used with large femoral heads, are made of cobalt-chromium, or have ovaloid or round cross-sectional shapes. Large increases in PFF risk were associated with cobalt-chromium stems used with low-viscosity cement. Further study is required to confirm causation.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
全髋关节置换术（THR）中使用水泥固定的抛光锥形滑（PTS）股骨柄具有出色的长期效果，但与复合梁柄相比，术后假体周围股骨骨折（PFF）的风险更高。本研究旨在确定与 PTS 柄 THR 后 PFF 翻修相关的危险因素。
在一项回顾性队列研究中，纳入了来自英格兰、威尔士、北爱尔兰和马恩岛国家关节登记处（NJR）的 299019 例使用 PTS 柄的初次 THR 病例，中位随访时间为 5.2 年（四分位距[IQR]，3.1 至 8.2 年）。使用多变量 Cox 生存回归分析估计每个变量的 PFF 翻修调整后的危险比（HR）。
在 299019 例 THR 病例中，1055 例因 PFF 接受了翻修，中位时间为 3.1 年（IQR，1.0 至 6.1 年）。平均年龄（标准差）为 72 ± 9.7 岁，64.3%（192365 例）为女性，82.6%（247126 例）为美国麻醉医师协会（ASA）分级 1 或 2 级。与 PFF 增加相关的变量包括年龄增长（HR，每年 1.02）、术中骨折（HR，2.57 [95%置信区间（CI），1.42 至 4.66]）、椭圆形（HR，1.96 [95% CI，1.22 至 3.16]）和圆形横截面形状（HR，9.58 [95% CI，2.29 至 40.12]）、股骨柄偏移增加（HR，每毫米 1.07）、股骨头尺寸增加（HR，每毫米 1.04）、2012 年至 2016 年进行 THR（HR，1.45 [95% CI，1.18 至 1.78]）、钴铬柄材料（HR，6.7 [95% CI，3.0 至 15.4]）和钴铬柄与低粘度水泥（HR，22.88 [95% CI，9.90 至 52.85]）。与 PFF 翻修风险降低相关的变量包括女性（HR，0.52 [95% CI，0.45 至 0.59]）、股骨柄长度增加（HR，每毫米 0.97）和陶瓷对聚乙烯轴承（HR，0.55 [95% CI，0.36 至 0.85]）。
PFF 翻修风险增加与短柄、高偏移量、大股骨头、钴铬材质、椭圆形或圆形横截面形状的 PTS 柄有关。与钴铬柄与低粘度水泥联合使用相关的 PFF 风险显著增加。需要进一步研究以确认因果关系。
治疗性 III 级。有关证据水平的完整描述，请参见作者说明。
