Oe Kenichi, Iida Hirokazu, Toyoda Takashi, Nakamura Tomohisa, Okamoto Naofumi, Saito Takanori
Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
Arthroplast Today. 2022 Aug 15;17:36-42. doi: 10.1016/j.artd.2022.07.007. eCollection 2022 Oct.
The removal of a well-fixed cementless stem poses technical challenges. The aim of this study was to evaluate the outcomes of our endofemoral extraction technique established in 2001.
Between January 2001 and December 2016, 118 consecutive revisions following bipolar or total hip arthroplasty, which required cementless femoral stem removal, were performed at our institution. This retrospective study evaluated 106 patients (108 hips) who were followed up for a mean of 9.2 years (range, 5-20 years). The patients included 15 men and 91 women with a mean age of 65 years (range, 33-87 years). Endofemoral extracted stem removal was performed as follows. Multiple Kirschner wires were sequentially inserted into the interface between the implant and cortical bone, after which the implant was detached using a thin chisel. After the cementless stem was removed, it was replaced with a cemented stem using an autograft, as needed. Radiological loosening of the femoral stem was defined as definite or probable loosening, based on the criteria of Harris et al. Prosthesis survival was analyzed using the Kaplan-Meier method, with the endpoint set as repeat revision surgery for stem loosening or femoral fracture.
Re-revision surgery was performed in 7 hips. Stem loosening was observed in 4 hips, and the mean subsidence was 0.3 mm (0-3 mm). The 10-year survival rate was 97.7% (95% confidence interval, 93.2-100).
Our technique for removing well-fixed cementless stems yielded successful results.
取出固定良好的非骨水泥型股骨柄存在技术挑战。本研究的目的是评估我们于2001年建立的股骨内取出技术的效果。
2001年1月至2016年12月期间，在我们机构对118例双极或全髋关节置换术后连续翻修病例进行了非骨水泥型股骨柄取出术。这项回顾性研究评估了106例患者（108髋），平均随访9.2年（范围5 - 20年）。患者包括15名男性和91名女性，平均年龄65岁（范围33 - 87岁）。股骨内取出柄的操作如下。多根克氏针依次插入植入物与皮质骨之间的界面，然后用薄凿分离植入物。取出非骨水泥型股骨柄后，根据需要使用自体骨移植并用骨水泥型股骨柄进行置换。根据Harris等人的标准，股骨柄的放射学松动定义为明确或可能的松动。使用Kaplan - Meier方法分析假体生存率，终点设定为因柄松动或股骨骨折进行再次翻修手术。
7髋进行了再次翻修手术。4髋观察到柄松动，平均下沉0.3毫米（0 - 3毫米）。10年生存率为97.7%（95%置信区间，93.2 - 100）。
我们取出固定良好的非骨水泥型股骨柄的技术取得了成功的结果。
