Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan.
Department of Orthopaedic Surgery, Hokkaido Orthopaedic Memorial Hospital, Sapporo, Japan.
Arch Orthop Trauma Surg. 2023 Jun;143(6):3487-3493. doi: 10.1007/s00402-022-04518-x. Epub 2022 Aug 1.
There is still little information regarding the advantages of a using a polished tapered stem for Crowe Type IV developmental dysplasia of the hip (DDH). This study aimed to investigate the mid-term clinical and radiological outcomes of primary total hip arthroplasty (THA) with femoral shortening osteotomy using modular and polished tapered stems and to compare the results between the modular and polished tapered stems.
This retrospective review included 32 patients (37 hips) with Crowe type IV DDH who underwent primary THA with femoral shortening osteotomy using a modular stem (cementless group, 14 hips) or a polished tapered stem (cement group, 23 hips) between 1996 and 2018. Clinical data and radiographic assessments were reviewed to analyze the differences between the two groups.
The mean duration of patient follow-up of the cementless group (134.4 months) was longer than that of the cement group (75.5 months). There were no differences in clinical results, time of bone union, and survival rate between the two groups. However, the cementless group exhibited a higher ratio of intraoperative fracture and thinning of cortical bone including stress shielding, medullary changes, stem alignment changes, and osteolysis, compared to the cement group.
The findings of this study suggest that THA with femoral shortening osteotomy using both cemented and modular stems can provide satisfactory results. However, considering the occurrence of intraoperative fracture and radiographic analysis in the current study, the cement stem may have an advantage for patients with bone fragility and deterioration in bone quality.
对于 Crowe Ⅳ型发育性髋关节发育不良（DDH）患者，使用抛光锥形股骨柄的优势仍知之甚少。本研究旨在探讨股骨短缩截骨术治疗 Crowe Ⅳ型 DDH 的中期临床和影像学结果，并比较使用模块化和抛光锥形股骨柄的结果。
本回顾性研究纳入 1996 年至 2018 年间接受股骨短缩截骨术的 Crowe Ⅳ型 DDH 患者 32 例（37 髋），其中 14 髋采用非骨水泥固定的模块化股骨柄（非骨水泥组），23 髋采用骨水泥固定的抛光锥形股骨柄（骨水泥组）。回顾性分析两组患者的临床数据和影像学评估结果，以分析两组之间的差异。
非骨水泥组的平均随访时间（134.4 个月）长于骨水泥组（75.5 个月）。两组的临床结果、骨愈合时间和生存率无差异。然而，非骨水泥组术中骨折和皮质骨变薄的比例高于骨水泥组，包括应力遮挡、髓腔变化、柄位变化和骨溶解。
本研究结果表明，股骨短缩截骨术结合使用骨水泥和模块化股骨柄可获得满意的结果。然而，考虑到本研究中术中骨折和影像学分析的发生，对于骨质脆弱和骨质量恶化的患者，骨水泥股骨柄可能具有优势。
