Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Arch Orthop Trauma Surg. 2021 Jun;141(6):1057-1064. doi: 10.1007/s00402-020-03749-0. Epub 2021 Jan 23.
This report is the first study to compare the clinical outcomes between cementless and cemented femoral prostheses in total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for Crowe type IV hips.
We identified 26 hips in 20 patients who had undergone cemented (n = 13) or cementless (n = 13) THA with subtrochanteric femoral shortening osteotomy for Crowe type IV hips with a minimum follow-up period of 2 years. The mean follow-up period was 60.8 ± 33.9 months (24-120 months). We compared radiological findings, postoperative clinical recoveries, postoperative complications, and implant survival rates.
In both groups, there were no cases of aseptic loosening for the acetabular and femoral implant. In terms of bone union at the osteotomy site, the mean duration was significantly longer in the cemented group (9.8 ± 4.2 months) than in the cementless group (5.0 ± 1.9 months). The clinical hip score in gait and pain at 3 months postoperatively was significantly higher in the cemented group than in the cementless group, while there were no significant changes at other timepoints between two groups. The number of postoperative complications was not significantly different between the two groups. The implant survival rate was 92% in the cementless group and 100% in the cemented group at 5 years postoperatively (P = 0.31).
The cemented femoral prosthesis is superior to the cementless femoral prosthesis for early clinical recovery, while the duration required to achieve bone union at the osteotomy site is longer in the cemented femoral prostheses. It is possible for surgeons to perform successful hip reconstructions, regardless of the fixation method used for THA with shortening femoral osteotomy.
本报告是第一项比较在 Crowe Ⅳ型髋部行股骨转子下短缩截骨的全髋关节置换术（THA）中，骨水泥型与非骨水泥型股骨假体的临床结果的研究。
我们共纳入 20 例患者的 26 髋，这些患者均因 Crowe Ⅳ型髋行股骨转子下短缩截骨的 THA，其中 13 例采用骨水泥型假体，13 例采用非骨水泥型假体，随访时间均至少 2 年。平均随访时间为 60.8±33.9 个月（24-120 个月）。我们比较了影像学发现、术后临床恢复、术后并发症和假体生存率。
两组髋臼和股骨假体均无无菌性松动。在截骨部位的骨愈合方面，骨水泥组（9.8±4.2 个月）明显长于非骨水泥组（5.0±1.9 个月）。术后 3 个月时，骨水泥组在步态和疼痛方面的临床髋关节评分明显高于非骨水泥组，而两组在其他时间点均无显著差异。两组的术后并发症数量无显著差异。非骨水泥组的假体生存率为 92%，骨水泥组为 100%，两组在术后 5 年时（P=0.31）无显著差异。
在早期临床恢复方面，骨水泥型股骨假体优于非骨水泥型股骨假体，而骨水泥型股骨假体在截骨部位达到骨愈合所需的时间更长。对于行股骨转子下短缩截骨的 THA，无论采用哪种固定方法，外科医生都可以成功进行髋关节重建。
