Thorey F, Floerkemeier T, Windhagen H
Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Deutschland.
go:h (Gelenkchirurgie Orthopädie Hannover), Hannover, Deutschland.
Orthopadie (Heidelb). 2022 Oct;51(10):815-821. doi: 10.1007/s00132-022-04304-y. Epub 2022 Sep 7.
Osteonecrosis of the femoral head or avascular necrosis of the femoral head (HKN) is a complex disease that, without treatment, leads to infraction of the femoral head in most cases. In these cases, only replacement of the hip joint will help, although there is no clear recommendation of an arthroplasty type. In the last two decades, the treatment of primary and secondary coxarthrosis with short-shaft prostheses with different anchoring philosophies has increased. Since short-shaft fitting is a possible option especially in younger patients, the question arises about possible fittings of advanced HKN with these stem types, especially with metaphyseal anchorage. The aim of this study was to review the existing literature on the results of short stem prosthesis in HKN and to present the advantages and disadvantages of short stem prosthesis in osteonecrosis of the femoral head.
This review analyzes the existing studies on short stem arthroplasty for HKN.
Only a few studies exist that have analyzed clinical and radiologic outcomes of short stem replacement in HKN.
The existing short- and medium-term results show mostly good outcomes. However, it is difficult to draw a general conclusion due to differences in stem design and fixation. Short stems with primary diaphyseal fixation do not show an increased risk of failed osseointegration or loosening. Constructions with primary metaphyseal fixation should undergo MRI to rule out the possibility of necrosis extending beyond the femoral neck.
股骨头坏死或股骨头缺血性坏死（HKN）是一种复杂的疾病，若不进行治疗，大多数情况下会导致股骨头骨折。在这些病例中，尽管对于关节置换类型尚无明确推荐，但只有髋关节置换术会有帮助。在过去二十年中，采用不同固定理念的短柄假体治疗原发性和继发性髋关节炎的情况有所增加。由于短柄假体适配尤其是在年轻患者中是一种可行选择，因此对于晚期HKN采用这些柄型假体，特别是采用干骺端固定的假体是否可行的问题随之而来。本研究的目的是回顾关于HKN中短柄假体结果的现有文献，并阐述短柄假体在股骨头坏死中的优缺点。
本综述分析了关于HKN短柄关节置换术的现有研究。
仅有少数研究分析了HKN中短柄置换的临床和放射学结果。
现有的短期和中期结果大多显示良好。然而，由于柄设计和固定方式的差异，很难得出一般性结论。初次骨干固定的短柄假体未显示骨整合失败或松动风险增加。初次干骺端固定的假体应进行MRI检查，以排除坏死超出股骨颈的可能性。
