Department of Orthopaedic Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Arch Orthop Trauma Surg. 2022 Dec;142(12):4063-4073. doi: 10.1007/s00402-021-04273-5. Epub 2022 Jan 11.
Despite excellent long-term survival, total hip arthroplasty (THA) can fail due to aseptic loosening, dislocations, sepsis and periprosthetic fractures, all of which remain considerably burdensome. Aseptic loosening is one of the main causes of THA failure, often due to osteolysis, stress shielding and/or lack of primary stability. This study aimed to investigate stem-bone contact patterns of a long straight-tapered uncemented stem following primary THA, and to determine whether these contact patterns are related to preoperative femoral morphology and whether they influence postoperative outcomes.
The authors reviewed a continuous series of 60 hips (55 patients) that underwent primary THA using the Corail stem (DePuy, Leeds, UK). Patients were evaluated pre- and post-operatively using the Japanese Orthopaedic Association (JOA) score. Computed-tomography (CT) scans were performed preoperatively to assess femoral bone morphology, and immediate postoperatively to assess stem-bone contact patterns. Postoperative radiographs were performed to calculate the Engh score. Regression analyses were performed to determine associations of postoperative JOA and Engh score with 27 independent variables.
Forty-nine patients (54 hips) were assessed at 31 ± 8 months, with a JOA score of 92.9 ± 8.1 and an Engh score of 21.2 ± 1.9. Six patients (6 hips) were lost-to-follow-up. There were no revisions and only one complication (recurrent dislocation). Stem-bone contact patterns were associated with preoperative femoral morphology (sagittal CFI [p = 0.006], femoral offset [p = 0.028], and NSA [p = 0.022]), but were not associated with either postoperative JOA or postoperative Engh score.
The stem-bone contact patterns of a long straight-tapered uncemented stem are related to preoperative femoral morphology, but do not influence short-term postoperative outcomes. Contact patterns were related to preoperative femoral offset, NSA, and sagittal CFI, but not coronal CFI. Surgeons should, therefore, consider sagittal morphology for surgical planning and templating, in addition to the conventional parameters of coronal morphology.
尽管全髋关节置换术（THA）的长期生存率优异，但仍可能因无菌性松动、脱位、感染和假体周围骨折而导致失败，所有这些都仍然相当具有挑战性。无菌性松动是 THA 失败的主要原因之一，通常是由于骨溶解、应力遮挡和/或缺乏初始稳定性引起的。本研究旨在探讨初次 THA 后长直锥形非骨水泥柄的骨-柄接触模式，并确定这些接触模式是否与术前股骨形态有关，以及它们是否影响术后结果。
作者回顾性分析了 60 例（55 例患者）连续采用 Corail 柄（DePuy，Leeds，英国）进行初次 THA 的病例。患者术前和术后均采用日本矫形协会（JOA）评分进行评估。术前进行计算机断层扫描（CT）检查以评估股骨骨形态，术后即刻进行 CT 检查以评估骨-柄接触模式。术后进行 X 线片检查以计算 Engh 评分。进行回归分析以确定术后 JOA 和 Engh 评分与 27 个独立变量的相关性。
49 例患者（54 髋）在 31±8 个月时进行评估，JOA 评分为 92.9±8.1，Engh 评分为 21.2±1.9。6 例患者（6 髋）失访。无翻修病例，仅发生 1 例并发症（复发性脱位）。骨-柄接触模式与术前股骨形态有关（矢状面 CFI[p=0.006]、股骨偏心距[p=0.028]和 NSAd[p=0.022]），但与术后 JOA 或术后 Engh 评分无关。
长直锥形非骨水泥柄的骨-柄接触模式与术前股骨形态有关，但不影响短期术后结果。接触模式与术前股骨偏心距、NSA 和矢状面 CFI 有关，与冠状面 CFI 无关。因此，外科医生在进行手术规划和模板设计时，除了考虑冠状面形态的常规参数外，还应考虑矢状面形态。
