Blankstein Michael, Haimes Mark A, Nelms Nathaniel J
From the University of Vermont Medical Center, Orthopedics and Rehabilitation Center, and the Department of Orthopaedics and Rehabilitation, The Robert Larner, M.D., College of Medicine at The University of Vermont, Burlington, VT.
J Am Acad Orthop Surg. 2022 Oct 15;30(20):e1279-e1290. doi: 10.5435/JAAOS-D-22-00074. Epub 2022 Aug 11.
Noncemented press-fit femoral stems predominate in total hip arthroplasty for all age groups with generally excellent long-term survivorship. The 2021 American Joint Replacement Registry reports that 96% of all elective primary total hip arthroplasties used noncemented femoral implant fixation. 1 Today, there are many styles of press-fit stems, each with supposed benefits, based on a range of design philosophies. Design aspects to consider when selecting a stem are numerous, including stem geometry, stem length, collared or collarless, material properties, and surface structure. Although most stem designs demonstrate excellent results, the differences in stem designs are intimately linked to additional factors such as ease of use/implantation, percentage of surface osseointegration, overall bone removal versus bone stock preservation, subsequent femoral stress shielding, and consideration of complexity of later revision. A surgeon with a broad understanding and appreciation of femoral stem designs should be prepared to select between the multitude of options to best serve individual patients.
在全髋关节置换术中，非骨水泥压配型股骨柄在所有年龄组中占主导地位，长期生存率总体良好。2021年美国关节置换登记处报告称，所有择期初次全髋关节置换术中96%使用了非骨水泥股骨植入物固定。如今，有许多类型的压配型股骨柄，基于一系列设计理念，每种都有其假定的优点。选择股骨柄时要考虑的设计因素众多，包括股骨柄几何形状、股骨柄长度、有领或无领、材料特性以及表面结构。尽管大多数股骨柄设计都显示出优异的效果，但股骨柄设计的差异与其他因素密切相关，如使用/植入的难易程度、表面骨整合百分比、整体骨去除与骨量保留、随后的股骨应力遮挡以及后期翻修复杂性的考量。对股骨柄设计有广泛理解和认识的外科医生应准备好在众多选项中进行选择，以最好地服务于个体患者。
