Eftekhar N S, Nercessian O
College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York.
Orthop Clin North Am. 1988 Jul;19(3):557-66.
Clinical results today seem to suggest that acrylic cement is crucial in producing immediate and reproducible results of pain-free joints following total hip replacement. Proper application by the use of contemporary techniques may be suitable in most conditions requiring hip replacement. The incidence of acetabular failure in a specific group of patients at risk may warrant experimentation by the use of a noncemented system. The mechanism of failure of low-friction arthroplasty may be multifaceted, but our experience indicates that the mechanisms of failure of the acetabulum have been due to excessive deepening and expansion of the acetabulum, once thought to be fundamental to the procedure. A rudimentary technique of cement pressurization, both in the femur and in the acetabulum, also may have played a part in late failures of this procedure. Early demarcation at the cement-bone interface was prevalent in young and active or heavy individuals. Demarcation and loosening were time-dependent phenomena. Demarcation and loosening also appeared with the aging process and increased osteopenia. A higher incidence of loosening also was observed in young and light-weight individuals, with presumably increased elasticity of the pelvic bone.
如今的临床结果似乎表明，骨水泥在全髋关节置换术后实现无痛关节的即时且可重复的效果方面至关重要。在大多数需要髋关节置换的情况下，采用当代技术进行正确应用可能是合适的。在特定高危患者群体中，髋臼失败的发生率可能需要通过使用非骨水泥系统进行试验。低摩擦关节成形术的失败机制可能是多方面的，但我们的经验表明，髋臼失败的机制是髋臼过度加深和扩大，这曾被认为是该手术的基本特征。在股骨和髋臼中进行骨水泥加压的基本技术，也可能在该手术的晚期失败中起到了一定作用。在年轻、活跃或体重较大的个体中，骨水泥-骨界面的早期分界很普遍。分界和松动是时间依赖性现象。分界和松动也随着衰老过程和骨质减少的增加而出现。在年轻和体重较轻的个体中，由于骨盆骨弹性可能增加，也观察到了较高的松动发生率。
