Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Germany.
Orthopaedicum Darmstadt, Rheinstraße 19, 64283, Darmstadt, Germany.
Arch Orthop Trauma Surg. 2024 Mar;144(3):1369-1377. doi: 10.1007/s00402-023-05066-8. Epub 2023 Oct 24.
Modular femoral components allow for patient-specific restoration of hip joint geometry and the reconstruction of extensive bone defects in revision total hip arthroplasty (THA); however, potential problems of modular implants such as taper corrosion and the risk of implant fracture continue to be of concern. The aim of the present study was to evaluate the clinical and radiological results of a cementless modular revision stem following revision surgery due to aseptic loosening and periprosthetic fracture and to assess patient-reported outcome measures (PROMs) in these patients at mid-term follow-up.
In this study, a consecutive cohort of 75 patients who underwent primary revision THA at our institution using a modular cementless stem design (MRP-TITAN stem) was retrospectively evaluated at a mean follow-up of 7.7 years. Kaplan-Meier survivorship analyses were performed with revision of the femoral component for any reason as the end point. The Harris-Hip Score, the UCLA Activity Score, the Forgotten Joint Score and the SF-12 Score were used for clinical assessment. We used the Wilcoxon signed rank test to compare pre- and postoperative clinical scores.
Overall stem survival with the endpoint stem re-revision for any reason was 85.4% at a mean follow-up of 7.7 years (range 2.4-14 years). Stem survival was 89.5% in the aseptic loosening group and 78.3% in the periprosthetic fracture group with no statistically significant difference between both groups (p = 0.107). One patient had to be revised due to taper fracture. PROMs improved significantly up to the latest follow-up, and radiographic evaluation showed full osseointegration of all stems in this cohort.
Revision THA using a modular cementless titanium revision stem demonstrated adequate clinical and radiological results at mid- to long-term follow-up in this cohort. Cementless revision stems are a useful treatment option to restore the anatomy, especially in deformed hips and in complex revision hip arthroplasty. However, there are some significant disadvantages related to an increased risk of mechanical failure such as corrosion/fretting damage and implant fracture. Future high-quality prospective studies with longer follow-up are necessary to confirm the supposed advantages.
模块化股骨假体可实现患者特异性髋关节几何结构的重建，并在翻修全髋关节置换术中修复大范围的骨缺损；然而，模块化假体潜在的问题，如柄-臼界面腐蚀和假体断裂的风险，仍然令人担忧。本研究旨在评估因无菌性松动和假体周围骨折而接受翻修手术的非骨水泥式模块化翻修柄的临床和影像学结果，并评估这些患者在中期随访时的患者报告结局（PROMs）。
本研究回顾性分析了我院采用非骨水泥式模块化设计（MRP-TITAN 柄）行初次翻修全髋关节置换术的 75 例患者，平均随访 7.7 年。以任何原因翻修股骨侧为研究终点，进行 Kaplan-Meier 生存分析。采用 Harris 髋关节评分、UCLA 活动评分、被遗忘关节评分和 SF-12 评分进行临床评估。采用 Wilcoxon 符号秩检验比较术前和术后的临床评分。
以任何原因翻修股骨侧为研究终点，平均 7.7 年（2.4-14 年）随访时，总体柄的生存率为 85.4%。在无菌性松动组和假体周围骨折组，柄的生存率分别为 89.5%和 78.3%，两组间无统计学差异（p=0.107）。1 例患者因柄-臼界面断裂而翻修。PROMs 直至最近随访时显著改善，且在该队列中所有假体均完全实现骨整合。
在本队列中，采用非骨水泥式钛制模块化翻修柄行翻修全髋关节置换术可获得良好的中期至长期临床和影像学结果。非骨水泥式翻修柄是一种恢复解剖结构的有效治疗选择，特别是在髋关节畸形和复杂翻修髋关节置换术中。然而，由于柄-臼界面腐蚀/微动损伤和假体断裂等机械失效风险增加，存在一些显著的劣势。未来需要进行高质量、前瞻性、长期随访的研究来证实这些优势。
