Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2023 Jul;38(7S):S217-S222. doi: 10.1016/j.arth.2023.03.004. Epub 2023 Mar 10.
Extensively porous-coated cylindrical stems have demonstrated excellent results in revision total hip arthroplasties (THAs). However, most studies are midterm follow-ups and of modest cohort size. This study aimed to evaluate long-term outcomes of a large series of extensively porous-coated stems.
From 1992 to 2003, 925 extensively porous-coated stems were utilized in revision THAs at a single institution. The mean age was 65 years, and 57% of patients were males. Harris hip scores were calculated, and clinical outcomes were assessed. Radiographic assessment for stem fixation was categorized as either in-grown, fibrous stable, or loose according to Engh criteria. Risk analysis used Cox proportional hazard method. The mean follow-up was 13 years.
Mean Harris hip scores improved from 56 to 80 at the last follow-up (P < .001). Fifty-three femoral stems (5%) were rerevised: 26 for aseptic loosening, 11 for stem fractures, 8 for infection, 5 for periprosthetic femoral fractures, and 3 for dislocation. Cumulative incidence of aseptic femoral loosening and femoral rerevision for any reason were 3% and 6.4% at 20 years, respectively. Nine of eleven stem fractures occurred with 10.5-13.5 mm diameters (mean 6 years). Radiographic review of unrevized stems demonstrated 94% bone-ingrown. Demographics, femoral bone loss, stem diameter, and length were not predictors of femoral rerevision.
In this large series of revision THAs using a single extensively porous-coated stem design, the cumulative incidence of rerevision for aseptic femoral loosening was 3% at 20 years. These data confirm the durability of this stem in femoral revision, providing a long-term benchmark for newer uncemented revision stems.
Level IV, retrospective study.
广泛多孔涂层圆柱柄在翻修全髋关节置换术中表现出了优异的效果。然而，大多数研究都是中期随访，且队列规模较小。本研究旨在评估大量广泛多孔涂层柄的长期结果。
1992 年至 2003 年，在一家单中心机构中，有 925 个广泛多孔涂层柄被用于翻修全髋关节置换术。患者平均年龄为 65 岁，57%为男性。计算了 Harris 髋关节评分，并评估了临床结果。根据 Engh 标准，将骨长入、纤维稳定或松动分为三种类别，以评估股骨柄固定情况。使用 Cox 比例风险法进行风险分析。平均随访时间为 13 年。
末次随访时，Harris 髋关节评分从 56 分提高到 80 分（P <.001）。53 个股骨柄（5%）需要再次翻修：26 个因无菌性松动，11 个因柄骨折，8 个因感染，5 个因股骨假体周围骨折，3 个因脱位。20 年时无菌性股骨松动和任何原因导致的股骨再次翻修的累积发生率分别为 3%和 6.4%。11 个柄骨折中有 9 个发生在直径为 10.5-13.5mm（平均 6 年）的柄。未翻修的柄的影像学复查显示 94%为骨长入。患者人口统计学特征、股骨骨量丢失、柄直径和长度均不是股骨再次翻修的预测因素。
在使用单一广泛多孔涂层柄设计的大量翻修全髋关节置换术中，20 年时无菌性股骨松动的再次翻修累积发生率为 3%。这些数据证实了该柄在股骨翻修中的耐用性，为新型非骨水泥翻修柄提供了长期的基准。
IV 级，回顾性研究。
