London Health Sciences Centre, University Hospital, London, Ontario, Canada.
University Hospital Coventry & Warwichshire NHS Trust, United Kingdom.
J Arthroplasty. 2022 Nov;37(11):2208-2213. doi: 10.1016/j.arth.2022.05.019. Epub 2022 May 14.
The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA).
A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness.
On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness ≥2mm was achieved in all Gruen zones for both approaches.
In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found.
本研究旨在比较无领抛光锥形水泥固定柄通过直接前入路（DAA）和直接外侧入路（DLA）插入时的柄尖端对准和水泥套质量。
对 232 例使用无领抛光锥形水泥固定柄的混合全髋关节置换术进行了回顾性比较研究，其中通过 DAA（n=147）或 DLA（n=85）插入。影像学评估包括柄尖端对准、水泥套质量和水泥套厚度。
在前后位 X 线片上，通过 DLA 植入的柄更可能处于中立对准，而通过 DAA 植入的柄则更可能处于倾斜对准（83.5%[n=71]比 71.4%[n=105]；P<.001）。在侧位 X 线片上或水泥套质量方面，两种入路方式之间的柄尖端对准无差异。多变量分析显示与水泥套质量不佳相关的因素包括 Dorr 型 B 或 C 股骨以及男性性别。两种方法的所有 Gruen 区均实现了平均水泥套厚度≥2mm。
在我们的系列研究中，与 DLA 相比，使用水泥固定锥形抛光股骨组件进行全髋关节置换术时，DAA 与冠状面柄尖端对线不良的发生率较高。未发现侧位柄尖端对准或水泥套质量存在差异。
