Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea.
Clin Orthop Surg. 2023 Oct;15(5):734-739. doi: 10.4055/cios23052. Epub 2023 Sep 15.
To report the long-term clinical and radiologic results of impaction bone grafting and standard cemented polished stem for femoral revision arthroplasty in patients with extensive bone deficiency.
We retrospectively reviewed 47 hips that underwent femoral revision hip arthroplasty using an impaction-morselized allograft with a standard cemented polished stem. The average age at the time of revision hip arthroplasty was 55 years (range, 39-75 years). The modified Harris hip score (HHS) was used for clinical evaluation. The radiologic evaluation focused on stem subsidence, stem position, progressive radiolucent lines, bone remodeling, and the incorporation of allografts.
The modified HHS improved from an average of 55.04 (range, 25-79.5) preoperatively to 90.1 (range, 81-93.2) at the last follow-up. The mean follow-up duration was 13.5 years (10.9-17.8 years). The radiographic analysis revealed stable stems. Femoral stems showed an average subsidence of 3.2 mm (range, 2-8 mm) in the cement mantle. However, there was no mechanical failure or subsidence of the cement mantle in the femurs. The stem position was neutral or varus less than 5°. No progressive radiolucent line or osteolysis was observed. Evidence of cortical and trabecular remodeling was observed in all cases. There were four cases of intraoperative cracks and four cases of distal femur splitting.
Initial stem stability using impaction bone grafting and a standard cemented polished stem in femoral revision arthroplasty resulted in good outcome. Delicate impaction grafting techniques and intraoperative crack and splitting fixation are the points that need attention for successful long-term results.
报告广泛骨缺损患者股骨翻修中采用打压植骨和标准抛光水泥固定股骨柄的长期临床和影像学结果。
我们回顾性分析了 47 例采用打压植骨和标准抛光水泥固定股骨柄的股骨翻修髋关节置换术患者。翻修时的平均年龄为 55 岁（39-75 岁）。采用改良 Harris 髋关节评分（HHS）进行临床评估。影像学评估重点关注柄下沉、柄位置、进行性透亮线、骨重塑和移植物的整合。
改良 HHS 从术前平均 55.04（25-79.5）提高到末次随访时的 90.1（81-93.2）。平均随访时间为 13.5 年（10.9-17.8 年）。影像学分析显示股骨柄稳定。股骨柄在骨水泥套中平均下沉 3.2mm（2-8mm）。然而，股骨中没有发生骨水泥套的机械性失败或下沉。柄位置为中性或小于 5°的内翻。未观察到进行性透亮线或骨溶解。所有病例均可见皮质和松质骨重塑的证据。术中发现 4 例有裂缝，4 例股骨远端劈裂。
在股骨翻修中采用打压植骨和标准抛光股骨柄可获得初始的柄稳定性，从而获得良好的结果。精细的打压植骨技术和术中裂缝及劈裂固定是获得成功长期结果需要注意的要点。
