Li Yicheng, Cao Li
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Hip Pelvis. 2024 Jun 1;36(2):101-107. doi: 10.5371/hp.2024.36.2.101.
Treatment of femoral bone defects continues to be a challenge in revision total hip arthroplasty (THA); therefore, meticulous preoperative evaluation of patients and surgical planning are required. This review provides a concise synopsis of the etiology, classification, treatment strategy, and prosthesis selection in relation to femoral bone loss in revision THA. A search of literature was conducted for identification of research articles related to classification of bone loss, management of femoral revision, and comparison of different types of stems. Findings of a thorough review of the included articles were as follows: (1) the Paprosky classification system is used most often when defining femoral bone loss, (2) a primary-length fully coated monoblock femoral component is recommended for treatment of types I or II bone defects, (3) use of an extensively porouscoated stem and a modular fluted tapered stem is recommended for management of types III or IV bone defects, and (4) use of an impaction grafting technique is another option for improvement of bone stock, and allograft prosthesis composite and proximal femoral replacement can be applied by experienced surgeons, in selected cases, as a final salvage solution. Stems with a tapered design are gradually replacing components with a cylindrical design as the first choice for femoral revision; however, further confirmation regarding the advantages and disadvantages of modular and nonmodular stems will be required through conduct of higher-level comparative studies.
在翻修全髋关节置换术（THA）中，股骨骨缺损的治疗仍然是一项挑战；因此，需要对患者进行细致的术前评估并制定手术计划。本综述简要概述了翻修THA中与股骨骨量丢失相关的病因、分类、治疗策略及假体选择。通过检索文献以识别与骨量丢失分类、股骨翻修处理及不同类型股骨柄比较相关的研究文章。对纳入文章进行全面综述的结果如下：（1）在定义股骨骨量丢失时，最常使用Paprosky分类系统；（2）对于I型或II型骨缺损，建议使用初次长度的全涂层一体式股骨假体；（3）对于III型或IV型骨缺损，建议使用广泛多孔涂层股骨柄和模块化带槽锥形股骨柄；（4）使用打压植骨技术是改善骨量的另一种选择，在特定病例中，经验丰富的外科医生可应用同种异体骨假体复合物和股骨近端置换作为最终挽救方案。锥形设计的股骨柄正逐渐取代圆柱形设计的部件，成为股骨翻修的首选；然而，需要通过开展更高水平的比较研究，进一步证实模块化和非模块化股骨柄的优缺点。
