Department of Orthopaedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands.
Department for Scientific Research, Sint Maartenskliniek, Ubbergen, The Netherlands.
J Arthroplasty. 2022 Nov;37(11):2239-2246. doi: 10.1016/j.arth.2022.05.009. Epub 2022 May 7.
In the revisions for Paprosky type II femoral defects, diaphyseal fixating femoral stems are commonly used. To preserve bone stock, the use of a shorter primary conical stem could be an adequate alternative. The objective of this study is to compare the results of a primary conical stem to the more commonly used diaphyseal fixating modular revision stem in revision total hip arthroplasty surgery with Paprosky type II femoral defects.
A total of 59 consecutive patients with Paprosky type II femoral defects from our prospective revision registry were included. Thirty patients who received a long distal fixating modular stem (Revision Stem, Lima Corporate) and 29 patients who received a primary conical short stem (Wagner Cone, Zimmer) were prospectively followed. Minimal follow-up time was 2 years for subsidence and patient-reported outcome measures and 5 years for complications, reoperation, and revision. We compared subsidence, perioperative complications, reoperations, femoral component survival, Oxford Hip Score, EuroQol 5 Dimension, visual analog scale (VAS) for pain at rest, and VAS for pain during activity between stems.
Both groups were comparable regarding demographic, clinical, and surgery-related characteristics. We found more perioperative complications and stem revisions with the modular revision stem than with the primary conical stem. There were no statistical differences in subsidence, EuroQol 5 Dimension, Oxford Hip Score, and VAS for pain at rest or during activity between both stems.
In revision total hip arthroplasty with Paprosky type II femoral defects, uncemented primary monobloc conical femoral stems showed the same clinical result as distal fixating modular stems with fewer complications and fewer stem revisions.
在 Paprosky Ⅱ型股骨缺损的翻修中，常使用骨干固定股骨柄。为了保留骨量，使用较短的初始锥形柄可能是一种足够的替代方法。本研究的目的是比较初始锥形柄与更常用的骨干固定模块化翻修柄在 Paprosky Ⅱ型股骨缺损翻修全髋关节置换术中的结果。
我们从前瞻性翻修登记处共纳入 59 例 Paprosky Ⅱ型股骨缺损的连续患者。30 例患者接受长的远端固定模块化柄（Revision Stem，Lima Corporate），29 例患者接受初始锥形短柄（Wagner Cone，Zimmer），前瞻性随访。下沉和患者报告的结果测量的最小随访时间为 2 年，并发症、再次手术和翻修为 5 年。我们比较了两种柄之间的下沉、围手术期并发症、再次手术、股骨组件存活率、牛津髋关节评分、欧洲五维健康量表、静息时疼痛视觉模拟评分和活动时疼痛视觉模拟评分。
两组在人口统计学、临床和手术相关特征方面具有可比性。我们发现使用模块化翻修柄的患者围手术期并发症和柄翻修更多。两种柄之间在下沉、欧洲五维健康量表、牛津髋关节评分和静息时或活动时疼痛的视觉模拟评分方面没有统计学差异。
在 Paprosky Ⅱ型股骨缺损的翻修全髋关节置换术中，非骨水泥初始一体式锥形股骨柄与远端固定模块化柄具有相同的临床效果，但并发症更少，柄翻修更少。
