Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 11217, Taiwan.
Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Arch Orthop Trauma Surg. 2024 Jun;144(6):2839-2847. doi: 10.1007/s00402-024-05361-y. Epub 2024 May 13.
The choice between a cementless taper wedge stem and a fit-and-fill stem in total Hip arthroplasty (THA) for various proximal femoral morphological types has not been thoroughly evaluated. This study aimed to compare the risk of stem-related complications between these two stem types in Dorr type A, B, and C femurs.
From January 2015 through April 2021, we retrospectively reviewed 1995 cementless THA procedures. We stratified all procedures into three groups: Dorr type A (N = 360, 18.0%), B (N = 1489, 74.7%) and C (N = 146, 7.3%). The primary outcome domain was stem-related complications, including stem subsidence ≥ 3 mm, intraoperative fracture, periprosthetic fracture and aseptic stem loosening. We performed multivariate regression analysis to compare the risk of stem-related complication between the two stem types. Other factors included age, sex, body mass index, diagnosis, age-adjusted Charlson comorbidity index, stem alignment and canal fill ratio.
The incidence of stem-related complications in the taper wedge and fit-and-fill stem groups was 4.4% (N = 15) and 6.5% (N = 107), respectively. Fit-and-fill stems showed an increased risk of stem-related complications (aOR: 9.903, 95% CI: 1.567-62.597) only in Dorr type C femurs. No significant difference in risk was observed in Dorr type A and B femurs. Furthermore, the canal fill ratio at the lesser trochanter, 2 cm and 7 cm below the lesser trochanter, did not exhibit an association with stem-related complications in any Dorr type.
Concerning the risk of stem-related complications, the taper wedge stem was a better choice in Dorr type C femurs. However, there was no difference in risk between the taper wedge stem and fit-and-fill stem in Dorr type A and B femurs.
在全髋关节置换术（THA）中，对于各种股骨近端形态类型，选择非骨水泥锥形楔形柄和适配填充柄之间尚未得到彻底评估。本研究旨在比较这两种柄在 Dorr 型 A、B 和 C 股骨中的与柄相关并发症的风险。
从 2015 年 1 月至 2021 年 4 月，我们回顾性分析了 1995 例非骨水泥 THA 手术。我们将所有手术分为三组：Dorr 型 A（N=360，18.0%）、B（N=1489，74.7%）和 C（N=146，7.3%）。主要结局是与柄相关的并发症，包括柄下沉≥3mm、术中骨折、假体周围骨折和无菌性柄松动。我们进行了多变量回归分析，以比较两种柄类型之间与柄相关并发症的风险。其他因素包括年龄、性别、体重指数、诊断、年龄调整 Charlson 合并症指数、柄的对线和管腔填充率。
锥形楔形柄和适配填充柄组与柄相关并发症的发生率分别为 4.4%（N=15）和 6.5%（N=107）。仅在 Dorr 型 C 股骨中，适配填充柄显示与柄相关并发症的风险增加（aOR：9.903，95%CI：1.567-62.597）。在 Dorr 型 A 和 B 股骨中，风险无显著差异。此外，在 Dorr 型任何一种股骨中，小转子下、小转子下 2cm 和 7cm 处的管腔填充率与柄相关并发症均无关联。
在与柄相关并发症的风险方面，锥形楔形柄在 Dorr 型 C 股骨中是更好的选择。然而，在 Dorr 型 A 和 B 股骨中，锥形楔形柄和适配填充柄之间的风险没有差异。
