Department of Orthopedic Surgery, Mayo Clinic Rochester, Rochester, MN; Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Department of Orthopedic Surgery, Mayo Clinic Rochester, Rochester, MN.
J Arthroplasty. 2020 Dec;35(12):3692-3696. doi: 10.1016/j.arth.2020.06.038. Epub 2020 Jun 18.
Modular fluted tapered (MFT) stems are the most frequently used femoral component in revision total hip arthroplasties (THAs). Despite this, no data are available on how they perform in revision THA for oncologic salvage. This is a unique population, often with severe bone loss and prior radiation that extends the limits of uncemented femoral reconstruction. The aims of this study were to evaluate the implant survivorship, radiographic results, and clinical outcomes of MFT stems used for revision oncologic salvage.
We identified 17 patients treated initially with primary THA for an oncologic diagnosis (15 primary oncologic, 2 metastatic disease) who underwent subsequent femoral revision with an MFT stem. Mean age at revision was 66 years and 35% of patients were female. Mean follow-up was 4 years. Before revision, 5 of 17 had undergone local radiation.
Ten-year survivorship free from aseptic loosening was 100%. The survivorship free of any reoperation was 76%. There were no femoral component fractures. Three patients were revised for recurrent instability, and 1 patient underwent irrigation and debridement for an acute infection. At most recent follow-up, no patient had radiographic evidence of progressive femoral component subsidence or failure of osteointegration. The mean Harris Hip Score improved from 29 preoperatively to 76 postoperatively (P < .0001).
In this series of patients with cancer, many of whom had severe bone loss and/or prior local radiation, being treated with revision THA, there were no revisions for femoral component loosening and no cases of implant fracture.
III.
模块化带槽锥形（MFT）柄是翻修全髋关节置换术（THA）中最常使用的股骨部件。尽管如此，对于骨肿瘤保肢翻修 THA 中 MFT 柄的表现，尚无相关数据。这是一个独特的人群，常伴有严重的骨质流失和先前的放疗，这增加了非骨水泥股骨重建的难度。本研究旨在评估 MFT 柄用于骨肿瘤保肢翻修的植入物存活率、影像学结果和临床结果。
我们确定了 17 名最初因骨肿瘤诊断而行初次 THA 治疗的患者（15 例原发性骨肿瘤，2 例转移性疾病），随后进行了 MFT 柄的股骨翻修。翻修时的平均年龄为 66 岁，35%的患者为女性。平均随访时间为 4 年。在翻修前，17 例中有 5 例接受了局部放疗。
10 年无无菌性松动生存率为 100%。无任何再手术生存率为 76%。无股骨部件骨折。3 例患者因复发性不稳定而翻修，1 例患者因急性感染行灌洗清创术。在最近一次随访时，没有患者出现股骨部件进行性下沉或骨整合失败的影像学证据。术前平均 Harris 髋关节评分为 29 分，术后为 76 分（P <.0001）。
在本系列癌症患者中，许多患者存在严重的骨质流失和/或先前的局部放疗，接受了翻修 THA 治疗，没有因股骨部件松动而进行翻修，也没有发生假体骨折。
III 级。
