Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O. Ortopedia e Traumatologia Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy.
Dipartimento dell'Anca e Traumatologico, IRCCS Policlinico San Donato, Milan, Italy.
BMC Musculoskelet Disord. 2021 Jan 6;22(1):29. doi: 10.1186/s12891-020-03886-y.
The aim of this paper is to evaluate the clinical and radiological outcomes of a fluted tapered modular distal-fixation stem at medium to long-term follow-up. The hypothesis of this investigation was to verify if the use of this implant design may have provided potential advantages in femoral revisions and post-traumatic instances where the restoration of the anatomy was the prime concern.
We retrospectively reviewed 62 cases of femoral revision surgeries, performed in Paprosky type IIIA and IIIB bone defects between January 2001 and December 2011 with a mean follow-up of 8.5 ± 1.5 years (range 5.1-15.9 years) where a modular fluted stem was used. The clinical assessment was performed with the Harris Hip Score (HHS), and the radiographic evaluation was carried in order to assess the stability of the femoral component. Intra-operative and postoperative complications were recorded, and the rates of complications and revisions for any cause were determined.
Mean HHS improved 35.4 points from the preoperative assessment. Radiographic evaluation showed a stable stem anchorage in 90.3% of the cases at the last follow-up. Five (8%) implants required additional surgery. Neither breakage of the stem nor loosening of the taper junction were recorded. Kaplan-Meier survivorship was 89.4% (CI: 88.8-90%) for any complication and 92.3% (CI: 91.8-92.7%) according to revision for any causes at 81 months follow-up.
Our findings suggest that this stem design is a reliable option in cases of complex femoral bone defects, as well as in cases with high functional deficiencies, with promising survivorship.
本文旨在评估一种带螺纹锥形模块化远端固定股骨柄在中至长期随访时的临床和影像学结果。本研究的假设是验证这种植入物设计是否可能在股骨翻修和创伤后病例中具有潜在优势，在这些病例中，恢复解剖结构是首要关注点。
我们回顾性分析了 2001 年 1 月至 2011 年 12 月期间 62 例 Paprosky Ⅲ A 和 Ⅲ B 型骨缺损的股骨翻修手术，平均随访 8.5±1.5 年（5.1-15.9 年），其中使用了模块化带螺纹股骨柄。临床评估采用 Harris 髋关节评分（HHS），影像学评估用于评估股骨部件的稳定性。记录术中及术后并发症，并确定并发症和任何原因的翻修率。
HHS 平均从术前评估提高了 35.4 分。在最后一次随访时，90.3%的病例显示股骨柄稳定固定。有 5 例（8%）需要进一步手术。未记录到柄的断裂或锥形连接松动。Kaplan-Meier 生存率为 89.4%（CI：88.8-90%），任何并发症的 81 个月随访时为 92.3%（CI：91.8-92.7%）。
我们的研究结果表明，这种柄设计是复杂股骨骨缺损病例以及功能严重不足病例的可靠选择，具有良好的生存率。
