Collis D K
Department of Orthopedics, University of Oregon Medical School, Eugene.
Orthop Clin North Am. 1988 Jul;19(3):541-50.
In conclusion, my 17-year experience with total hip arthroplasty leads me to believe that hip replacements can be done in a standard operating room if adequate preoperative precautions are taken, traffic in the operating room is strictly controlled, and prophylactic antibiotics are given (infection rate 0.28 per cent). Cemented resurface arthroplasty was not a successful enough operation to warrant its continued use (revision rate 44 per cent). The revision rate for all hips operated on 10 or more years ago was 7.0 per cent. In patients younger than fifty years of age, a revision rate of 19.6 per cent was observed after 10 years. Excessive body weight and heavy physical activity levels were frequently noted among the failures. Total hip arthroplasty should be done cautiously in patients under 50 and very rarely in patients under 30. Thirteen of the 25 revisions required in the early series were due to stem fracture, a complication rarely seen now with improved stem design and superalloy metallurgy. Despite radiologic identification of prosthesis loosening, revision THR may not be necessary for many years, if at all. Uncemented arthroplasty, particularly the acetabular component, seems to hold promise for the future; however, the experience to date is too limited to make any definite conclusions.
总之，我17年的全髋关节置换经验让我相信，如果采取充分的术前预防措施、严格控制手术室人员流动并给予预防性抗生素（感染率为0.28%），髋关节置换手术可以在标准手术室进行。骨水泥型表面置换术并非足够成功，不值得继续使用（翻修率为44%）。10年或更早之前接受手术的所有髋关节的翻修率为7.0%。在50岁以下的患者中，10年后的翻修率为19.6%。在翻修的病例中，经常发现体重超标和体力活动水平较高。50岁以下患者应谨慎进行全髋关节置换，30岁以下患者则极少进行。早期系列中25例翻修中有13例是由于股骨柄骨折，随着股骨柄设计的改进和超合金冶金技术的发展，这种并发症现在已很少见。尽管通过影像学检查发现了假体松动，但很多情况下多年内可能根本无需进行翻修全髋关节置换术。非骨水泥型置换术，尤其是髋臼部件，似乎对未来很有前景；然而，目前的经验有限，无法得出任何明确结论。
