İstanbul Kartal Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, 34865 Kartal, İstanbul, Türkiye.
Jt Dis Relat Surg. 2022;33(2):393-398. doi: 10.52312/jdrs.2022.525. Epub 2022 Jul 6.
This study aims to compare clinical and radiological follow-up results of a rectangular (SL-Plus®) or a round (Synergy®) femoral component in patients with Crowe type 2 or 3 hip dysplasia operated with total hip arthroplasty (THA) without a shortening osteotomy.
Between January 2012 and December 2017, a total of 34 hips of 30 female patients (mean age: 42.9±11.6 years; range, 24 to 66 years) were retrospectively analyzed. All patients were evaluated using the Harris Hip Score (HHS) and Visual Analog Scale (VAS) for pain pre- and postoperatively. Intra- and postoperative complications were noted. Evaluation criteria included leg length discrepancy, stem subsidence, bone atrophy or hypertrophy around the stem according to Gruen zones, operative time, and intraoperative blood loss. Correlation analysis of radiological, clinical findings, and stem size was performed.
The mean follow-up was 61.3±27.2 months. The mean postoperative HHS was 89.3±6.2 vs. 93.1±9.1, and the mean VAS score 1±0.6 vs. 1±0.8 in round and rectangular stem groups at the final follow-up. No significant differences were detected between the groups in any of the evaluated parameters, except for a more severe degree of stress shielding observed in the round stem group. Round stem size was positively correlated with a more severe stress shielding (r=0.55, p=0.020). No patient had to be revised during the follow-up period. The overall complication rate was 9%.
Successful and comparable results can be obtained with cementless THA in patients with high riding dysplastic hips implanting either of the femoral components, a rectangular or a round stem. Although the round stem was associated with more common proximal stress shielding, this was not associated with worse clinical outcomes.
本研究旨在比较 Crowe 2 或 3 型髋关节发育不良患者行全髋关节置换术（THA）时不进行短缩截骨，使用矩形（SL-Plus®）或圆形（Synergy®）股骨柄的临床和影像学随访结果。
2012 年 1 月至 2017 年 12 月，回顾性分析了 30 名女性患者（平均年龄：42.9±11.6 岁；范围 24 至 66 岁）的 34 髋。所有患者均采用 Harris 髋关节评分（HHS）和疼痛视觉模拟评分（VAS）进行术前和术后评估。记录术中及术后并发症。评估标准包括肢体长度差异、柄下沉、根据 Gruen 分区评估的柄周围骨萎缩或肥大、手术时间和术中失血量。对影像学、临床发现和柄大小进行相关性分析。
平均随访时间为 61.3±27.2 个月。术后平均 HHS 评分分别为圆形和矩形柄组的 89.3±6.2 和 93.1±9.1，平均 VAS 评分分别为 1±0.6 和 1±0.8。除在圆形柄组观察到更严重的应力遮挡外，两组在所有评估参数中均无显著差异。圆形柄的尺寸与更严重的应力遮挡呈正相关（r=0.55，p=0.020）。随访期间无患者需要翻修。总体并发症发生率为 9%。
在植入矩形或圆形股骨柄的高脱位发育不良髋关节患者中，采用非骨水泥 THA 可获得成功且可比的结果。虽然圆形柄与更常见的近端应力遮挡有关，但这与较差的临床结果无关。
