Nishi Masanori, Yoshikawa Yasushi, Okano Ichiro, Kaji Yasutaka, Usui Yuki, Okamoto Satoshi, Nakamura Shota, Kudo Yoshifumi, Nakamura Masanori, Miyaoka Hideyo
Orthopaedic Surgery, Showa University School of Medicine, Tokyo, JPN.
Cureus. 2024 Apr 4;16(4):e57633. doi: 10.7759/cureus.57633. eCollection 2024 Apr.
Introduction Advancements in bipolar hemiarthroplasty (BHA) implants in the mid-1990s contributed to favorable short-term outcomes for osteonecrosis of the femoral head (ONFH), particularly in cases without acetabular cartilage lesions. Nevertheless, long-term results remain unclear. In this study, we investigated (i) the impact of new-generation BHA implants and (ii) the effect of the preoperative stage on long-term outcomes in young patients with ONFH. Methods The records of consecutive patients with ONFH who underwent cementless BHA were retrospectively reviewed. Patients aged ≥60 years, with <10 years of follow-up, or who underwent acetabular reaming during surgery were excluded. Radiographical and clinical outcomes of patients who received first-generation BHAs and new-generation BHAs (developed after 1998) were compared by stratifying based on preoperative stage 2/3A and 3B/4, according to the Japanese Investigation Committee classification. Results Overall, 50 hips from 39 patients (mean age: 44.6 years; 64% male) with an average follow-up of 18.6 years were included. The frequency of advanced-stage patients was significantly higher in the first-generation BHA group than in the new-generation group. Regarding postoperative outcomes, the first-generation BHA group had higher acetabular erosion grades (p<0.001) and more femoral component loosening than those in the new-generation group (p<0.001). Revisions were performed in eight hips (seven in the first-generation and one in the new-generation BHA groups, p<0.001). In the new-generation BHA group, there were no significant differences in patient background between stage 2/3A and 3B/4 groups, and only one case in the stage 3B/4 group required revision. In the new-generation group, the grade of acetabular erosion was significantly higher for stage 3B/4 than stage 2/3A (p<0.001); other radiographical and clinical outcomes did not differ significantly between stages. Conclusion New-generation BHAs have significantly better implant survival rates for early-stage ONFH than those of first-generation BHAs. These findings indicate that BHA is an acceptable treatment option for early-stage ONFH in young patients.
引言 20世纪90年代中期双极半髋关节置换术（BHA）植入物的进展为股骨头坏死（ONFH）带来了良好的短期疗效，尤其是在没有髋臼软骨损伤的病例中。然而，长期结果仍不明确。在本研究中，我们调查了（i）新一代BHA植入物的影响以及（ii）术前阶段对年轻ONFH患者长期疗效的影响。方法 对连续接受非骨水泥型BHA的ONFH患者的记录进行回顾性分析。排除年龄≥60岁、随访时间<10年或手术中进行髋臼扩孔的患者。根据日本调查委员会的分类，按术前2/3A期和3B/4期对接受第一代BHA和新一代BHA（1998年后研发）的患者的影像学和临床结果进行比较。结果 总体而言，纳入了39例患者的50髋（平均年龄：44.6岁；64%为男性），平均随访18.6年。第一代BHA组晚期患者的比例显著高于新一代组。关于术后结果，第一代BHA组的髋臼侵蚀分级更高（p<0.001）且股骨组件松动比新一代组更多（p<0.001）。8髋进行了翻修（第一代BHA组7髋，新一代BHA组1髋，p<0.00）。在新一代BHA组中，2/3A期和3B/4期组患者背景无显著差异，3B/4期组仅1例需要翻修。在新一代组中，3B/4期的髋臼侵蚀分级显著高于2/3A期（p<0.001）；各期之间其他影像学和临床结果无显著差异。结论 新一代BHA在早期ONFH中的植入物生存率显著高于第一代BHA。这些发现表明BHA是年轻患者早期ONFH的一种可接受的治疗选择。
