Skibicki Hope E, Post Zachary D, Kay Andrew B, Czymek Miranda M, Ong Alvin C, Orozco Fabio R, Ponzio Danielle Y
Rowan University School of Osteopathic Medicine; Stratford, NJ.
Rothman Orthopaedic Institute; Egg Harbor Township, NJ.
J Arthroplasty. 2021 Sep;36(9):3269-3274. doi: 10.1016/j.arth.2021.04.042. Epub 2021 May 6.
In revision total hip arthroplasty (THA) cases with preserved femoral metaphyseal bone, tapered proximally porous-coated "primary" femoral stems may be an option. The objective of this study was to compare outcomes of patients with Paprosky I or II femoral bone loss undergoing revision THA with either a primary metaphyseal-engaging cementless stem or a revision diaphyseal-engaging stem.
This was a retrospective analysis of 70 patients with Paprosky I or II femoral bone loss who underwent femoral revision. 35 patients who were revised using a primary cementless femoral stem were compared with 35 patients who underwent femoral revision using a revision diaphyseal-engaging stem. The groups were similar regarding age, gender, body mass index, and American Society of Anesthesiologists. Clinical and radiographic outcomes and complications were compared over an average follow-up of 2.9 years (SD 1.4).
Revision THA was most commonly performed for periprosthetic joint infection (N = 27, 38.6%). The groups were similar with regards to Paprosky femoral classification (P = .56), length of stay (P = .68), discharge disposition (P = .461), operative time (P = .20), and complications (P = .164). There were no significant differences between primary and revision femoral stem subsidence (0.12 vs. 0.75 mm, P = .18), leg length discrepancy (2.3 vs. 4.05 mm, P = .37), and Hip Disability and Osteoarthritis Outcome Score Jr (73.1 [SD 21.1] vs. 62.8 [SD 21.7], P = .088). No patient underwent additional revision surgery involving the femoral component.
Use of modern primary cementless femoral stems is a viable option for revision hip arthroplasty in the setting of preserved proximal femoral metaphyseal bone. Outcomes are not inferior to those of revision stems and offer potential benefits.
在保留股骨干骺端骨质的翻修全髋关节置换术（THA）病例中，近端逐渐变细的多孔涂层“初次使用”股骨柄可能是一种选择。本研究的目的是比较接受翻修THA的Paprosky I或II型股骨骨缺损患者使用初次干骺端固定型非骨水泥股骨柄或翻修骨干固定型股骨柄的疗效。
这是一项对70例Paprosky I或II型股骨骨缺损并接受股骨翻修的患者的回顾性分析。将35例使用初次非骨水泥股骨柄进行翻修的患者与35例使用翻修骨干固定型股骨柄进行股骨翻修的患者进行比较。两组在年龄、性别、体重指数和美国麻醉医师协会分级方面相似。在平均2.9年（标准差1.4）的随访期内比较临床和影像学结果及并发症。
翻修THA最常见的原因是假体周围关节感染（n = 27，38.6%）。两组在Paprosky股骨分类（P = 0.56）、住院时间（P = 0.68）、出院情况（P = 0.461）、手术时间（P = 0.20）和并发症（P = 0.164）方面相似。初次股骨柄和翻修股骨柄的下沉（0.12对0.75 mm，P = 0.18）、下肢长度差异（2.3对4.05 mm，P = 0.37）以及髋关节功能障碍和骨关节炎结果评分Jr（73.1[标准差21.1]对62.8[标准差21.7]，P = 0.088）之间均无显著差异。没有患者接受涉及股骨组件的再次翻修手术。
在保留近端股骨干骺端骨质的情况下，使用现代初次非骨水泥股骨柄是翻修髋关节置换术的一个可行选择。其疗效不低于翻修股骨柄，且具有潜在益处。
