Melišík M, Hrubina M, Heřt J, Cibula Z, Čabala J, Nečas L
Ortopedická klinika Univerzitnej nemocnice a Jesseniovej lekárskej fakulty v Martine, Univerzity Komenského v Bratislave.
I. ortopedická klinika 1. lekárskej fakulty Univerzity Karlovej a Fakultnej nemocnice v Motole, Praha.
Acta Chir Orthop Traumatol Cech. 2021;88(1):50-57.
PURPOSE OF THE STUDY The aim of this study is to assess the mid-term results of this specific ultra-short, cementless stem in patients younger than 60 years with regard to clinical and radiographic outcomes, survivorship, complication rate and revisions. MATERIAL AND METHODS A consecutive series of one hundred and twenty-one patients (130 hips) younger than 60 years at the time of surgery was enrolled in the study. Primary arthritis (33.8%) and dysplastic hips (30%) were the most common diagnoses. The patients used crutches for 6 weeks to protect femoral components against subsidence and rotational stress. The mean follow-up was 118 months (range 96-156 months). RESULTS At the final evaluation, the mean Harris Hip Score was 98.8. A perioperative periprosthetic fracture occurred in two hips and a perioperative ceramic insert breakage was observed in one hip. One hip had ceramic insert fracture 3.5 years postoperatively. In one hip a dislocation occurred. These two hips (1.5%) were revised due to reasons not associated with the stem. One hip has aseptic asymptomatic polyethylene inlay wear. In two hips squeezing was reported. There were two cases of loosening and migration of stems (1.5%) with osteolysis all around the stems. These patients have moderate thigh pain. The radiological survival is 98.5% and the clinical survival is 100% after 10 years on average. DISCUSSION Although improved clinical results were reported in younger patients with standard cementless stems, some problems still prevail: thigh pain, proximal stress shielding, difficult removal of the stem. In an effort to reduce these problems, Proxima ultra-short anatomical cementless stem was developed. Several studies show that this stem design provides good short- and mid- term results, but only in a limited number of patients and relatively short follow-up. Furthermore, the initial fears of early aseptic loosening due to the absence of diaphyseal fixation were not confirmed. CONCLUSIONS Proxima ultra-short anatomical cementless stem provided excellent mid-term clinical and radiographic results in patients younger than 60 years. Key words: total hip arthroplasty, ultra-short cementless anatomical stem.
研究目的 本研究旨在评估这种特定的超短柄非骨水泥型假体柄在60岁以下患者中的中期结果，包括临床和影像学结果、生存率、并发症发生率及翻修情况。
材料与方法 本研究纳入了连续的121例患者（130髋），这些患者手术时年龄均小于60岁。原发性关节炎（33.8%）和发育性髋关节发育不良（30%）是最常见诊断。患者使用拐杖6周以保护股骨部件防止下沉和旋转应力。平均随访时间为118个月（范围96 - 156个月）。
结果 在最终评估时，平均Harris髋关节评分98.8分。两髋发生围手术期假体周围骨折，一髋观察到围手术期陶瓷内衬破裂。一髋在术后3.5年发生陶瓷内衬骨折。一髋发生脱位。这两髋（1.5%）因与假体柄无关的原因进行了翻修。一髋有无菌性无症状聚乙烯内衬磨损。两髋报告有挤压情况。有两例假体柄松动和移位（1.�%），假体柄周围有骨溶解。这些患者有中度大腿疼痛。平均10年后影像学生存率为98.5%，临床生存率为100%。
讨论 尽管在使用标准非骨水泥型假体柄的年轻患者中报告了改善的临床结果，但一些问题仍然存在：大腿疼痛、近端应力遮挡、假体柄取出困难。为了减少这些问题，研发了Proxima超短解剖型非骨水泥型假体柄。多项研究表明，这种假体柄设计提供了良好近期和中期结果，但仅在有限数量患者中且随访相对较短。此外，最初因缺乏骨干固定而对早期无菌性松动的担忧未得到证实。
结论 Proxima超短解剖型非骨水泥型假体柄在60岁以下患者中提供了出色的中期临床和影像学结果。
全髋关节置换术；超短非骨水泥解剖型假体柄
