Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
Department of Orthopaedics, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Orthop Surg. 2021 May;13(3):749-757. doi: 10.1111/os.12946. Epub 2021 Mar 5.
To compare the clinical and radiographic outcomes between the Tri-Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA).
From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri-Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well.
The mean follow-up time was 48.23 ± 2.91 months in the Tri-Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri-Lock (BPS) group (8% vs 1%, P = 0.030). At final follow-up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri-lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri-Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan-Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%-100%) in Tri-lock (BPS) group and 97.6% (95% confidence interval, 94.6%-100%) in Corail group.
The Tri-Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri-lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra-operative fracture. Therefore, we recommend the Tri-lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.
比较 Tri-Lock Bone Preservation Stem（BPS）与传统标准 Corail 柄在初次全髋关节置换术中的临床和影像学结果。
回顾性分析 2012 年 3 月至 2014 年 5 月间，84 例（104 髋）接受 Tri-Lock（BPS）和 84 例（115 髋）接受传统标准 Corail 柄初次全髋关节置换术的患者。他们的平均年龄分别为 53.12±2.32 岁和 52.00±2.11 岁。采用 Western Ontario and McMaster University Osteoarthritis Index（WOMAC）、疼痛视觉模拟量表（VAS）和 Harris 髋关节评分（HHS）评估临床结果。通过影像学检查评估影像学结果。此外，还观察了术中及术后并发症。
Tri-Lock（BPS）组的平均随访时间为 48.23±2.91 个月，Corail 组为 49.11±2.11 个月。两组的出血量相当（169.22±58.11ml 比 179.30±59.14ml，P=0.003），Corail 组患者的出血量较多，但手术时间无统计学意义（65.41±6.24min 比 63.99±6.33min，P=0.567）。Corail 组术中骨折发生率为 8%，Tri-Lock（BPS）组为 1%（8%比 1%，P=0.030）。末次随访时，两组 HHS、WOMAC 和疼痛 VAS 无统计学差异（P>0.05）。Corail 组大腿疼痛发生率高于 Tri-lock（BPS）组（5%比 0%，P=0.043）。然而，Tri-Lock（BPS）组 1 级应力遮挡的发生率高于 Corail 组（76%比 23%，P<0.01），而 2 级和 3 级的发生率低于 Corail 组（15%比 28%，P<0.01；9%比 16%，P=0.008）。有趣的是，两组在影像学结果和术后并发症方面的其他评估结果没有可比性。两组的 Kaplan-Meier 生存率（任何原因进行的翻修手术定义为终点）相似（P=0.57），Tri-lock（BPS）组为 98.8%（95%可信区间，92.3%-100%），Corail 组为 97.6%（95%可信区间，94.6%-100%）。
Tri-Lock（BPS）与 Corail 柄具有相似的临床疗效。此外，Tri-lock（BPS）柄在降低大腿疼痛、应力遮挡和术中骨折的发生率方面具有一些优势。因此，我们推荐 Tri-lock（BPS）柄作为初次全髋关节置换术的一种良好选择，特别是考虑到患者因素，包括骨量不足和髋关节翻修时柄的取出方便。
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