Hip Unit, Department of Orthopaedics, Centro Hospitalar E Universitário Do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal.
Eur J Orthop Surg Traumatol. 2022 May;32(4):693-700. doi: 10.1007/s00590-021-03017-w. Epub 2021 Jun 7.
Short-stem prostheses in hip arthroplasty have emerged as an alternative to conventional stems, especially in younger patients. The purpose of this study was to compare functional and radiological results of a short metaphyseal fitting cementless stem versus a conventional stem implant, in patients younger than 60 years.
All patients operated from January 2006 to April 2013 were included, obtaining a minimum follow-up of 7 years. Harris Hip Score (HHS) and SF-36 (quality of life) questionnaires were applied and the presence of "thigh pain" was specifically assessed. We also compared complication rate, revision rate and average prosthesis survival. Femoral stress shielding (Gruen scale), stem subsidence, varus-valgus tilt and implant stability (Engh scale) were also compared.
A total of 101 short-stem and 74 conventional arthroplasties were included, with an average follow-up of 9.82 (7-14) years. HHS functional score and SF-36 were excellent in both implants and no significant difference between them (p > 0.05) was found. However, "thigh pain" was present in 7 patients with conventional stems and none with short-stems (p < 0.001). The survival rate at 13 years was 99%, for both implants, and no significant differences were found between them (χ(2) = 0.178; p = 0.673). Conventional stems had stress shielding at the greater trochanter in 72% of the cases and 43% at the calcar, being statistically superior (p < 0.001) to the stress shielding observed in the short stems.
According to our results, this short-stem seems to allow preservation of bone stock, with decreased stress shielding and also a lower incidence of thigh pain compared to conventional stems.
Level III retrospective comparative study.
在髋关节置换术中，短柄假体已经成为传统假体的替代物，尤其是在年轻患者中。本研究的目的是比较短骨干匹配非骨水泥假体与传统假体在 60 岁以下患者中的功能和影像学结果。
纳入 2006 年 1 月至 2013 年 4 月期间接受手术的所有患者，随访时间至少 7 年。应用 Harris 髋关节评分（HHS）和 SF-36（生活质量）问卷，并特别评估“大腿疼痛”的存在。我们还比较了并发症发生率、翻修率和平均假体生存率。比较了股骨应力遮挡（Gruen 量表）、柄下沉、内翻-外翻倾斜和假体稳定性（Engh 量表）。
共纳入 101 例短柄和 74 例传统髋关节置换术患者，平均随访 9.82（7-14）年。两种假体的 HHS 功能评分和 SF-36 均为优秀，且无显著差异（p>0.05）。然而，传统假体中有 7 例出现大腿疼痛，而短柄假体中无 1 例（p<0.001）。两种假体的 13 年生存率均为 99%，无显著差异（χ(2)=0.178；p=0.673）。传统假体在大转子处有 72%发生应力遮挡，在距骼骨处有 43%发生应力遮挡，统计学上优于短柄假体（p<0.001）。
根据我们的结果，这种短柄假体似乎可以保留骨量，减少应力遮挡，与传统假体相比，大腿疼痛的发生率也较低。
III 级回顾性比较研究。
