Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, People's Republic of China.
BMC Surg. 2021 Apr 13;21(1):192. doi: 10.1186/s12893-021-01196-1.
The application of short femoral stems is partially restricted in revision surgery. This study will demonstrate the therapeutic effect and unsuitable situation for short stem revision.
Demographic characteristics of all patients were recorded in detail (Table 1). Anteroposterior view radiographic examinations of proximal femur are necessary before and after the operation for patients. The primary outcome of interest was the survival rate of the femoral stem at the final follow-up. Risk factors for failure were also investigated. The secondary outcomes of interest included the Harris hip score, excellent to good rate and incidence of complications. The Mann-Whitney U test was performed for comparisons between continuous variables. The chi-square test was performed for comparisons between categorical variables. Cox regression analysis was used to assess the association between potential risk factors and the failure of revision surgery.
A total of 381 patients with short stems were retrospectively reviewed. There were 188 males and 193 females. The average age and body mass index before revision surgery were 58.85 ± 13.46 years and 23.72 ± 3.40 kg/m, respectively. The mid-term survival rate of the short femoral component was 94.23%. The prognosis and complications of patients between the two groups were compared. There was no significant difference between the two groups in the Harris score, complication incidence or survival rate of the femoral component. The strongest risk factor in this study was intraoperative periprosthetic femoral fracture during revision surgery (HR = 5.477, 95% CI = 2.156-13.913).
Three risk factors for failure were identified: ageing, osteoporosis and intraoperative periprosthetic femoral fracture during revision surgery. Therefore, a short femoral stem should be implanted in patients with these risk factors with additional caution.
短柄股骨假体在翻修手术中的应用受到一定限制。本研究旨在展示短柄股骨假体翻修的疗效及不适用情况。
详细记录所有患者的人口统计学特征（表 1）。所有患者术前及术后均需行股骨近端正侧位 X 线检查。主要研究终点为最终随访时股骨柄的生存率。还对失败的风险因素进行了调查。次要研究终点包括 Harris 髋关节评分、优良率和并发症发生率。连续变量采用 Mann-Whitney U 检验进行比较，分类变量采用卡方检验进行比较。采用 Cox 回归分析评估潜在风险因素与翻修手术失败的相关性。
共回顾性分析了 381 例短柄股骨假体患者。其中男 188 例，女 193 例。翻修术前平均年龄和体重指数分别为 58.85±13.46 岁和 23.72±3.40 kg/m2。短柄股骨假体的中期生存率为 94.23%。比较了两组患者的预后和并发症情况。两组患者的 Harris 评分、并发症发生率和股骨假体生存率无统计学差异。本研究中最强的危险因素是翻修术中的股骨假体周围骨折（HR=5.477，95%CI=2.156-13.913）。
本研究确定了 3 个失败的危险因素：年龄、骨质疏松症和翻修术中的股骨假体周围骨折。因此，对于有这些危险因素的患者，应谨慎使用短柄股骨假体。
