Karatas Muhammed Enes, Kemah Bahattin, Soylemez Mehmet Salih, Saglam Necdet
Department of Orthopaedics and Traumatology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkiye.
North Clin Istanb. 2024 Jun 24;11(3):219-224. doi: 10.14744/nci.2023.38107. eCollection 2024.
The purpose of the present study was to evaluate the mid-term implant survivorship, modes of failure, radiographic results, and clinical outcomes of current cementless total hip arthroplasty (THA) treatment designs for steroid-induced avascular necrosis (AVN).
A time span of 5 years between January 2012 and November 2017 was scanned to accommodate 5 years of follow-up and a total of 15 patients (18 hips), who had undergone implantation of ultra-high molecular weight polyethylene (UHMWPE) and newly designed other head and liner components, were included in the study. Only patients operated for steroid-induced AVN were included in the study. Patients with alcohol-induced, idiopathic, and traumatic AVN were excluded from the study. The primary outcomes were the assessments of Harris Hip Score (HHS) and the presence of loosening, osteolysis, polyethylene wear or a reoperation (with or without revision of components). The fixation of cementless femoral components was assessed according to Engh criteria.
The study group consisted of 18 hips from 15 patients. The mean age was 47.6±8.1 (29-55) years. A cementless femoral stem and acetabular cup were used for all patients. Septic loosening was detected in all components of one patient (5.6%). The mean HHS score was 83.3±7.2 (60-92) for all patients. Of the 18 hips, 83% (15 hips), 5.6% (1 hip), 5.6% (1 hip), and 5.6% (1 hip) had good, poor, fair, and excellent HHS scores. Ceramic or polyethylene liner wear was not detected in any of the patients. The Engh Grading Scale revealed a "bone ingrowth" in 16 (89%) hips, "suspected in-growth" in 1 (5.6%) hip and "suboptimum but stable" femoral fixation in a patient with septic loosening (5.6%) just before revision surgery. There was no significant correlation between femoral stem design and Engh score (p=0.842).
Modern total hip arthroplasty systems, including ceramic on ceramic or ceramic on polyethylene headliner options with cementless femoral stem, offer promising mid-term survivorship and positive clinical outcomes for steroid-induced AVN treatment. However, studies including long-term follow-ups with larger sample size are needed to obtain more precise data.
本研究旨在评估当前用于治疗类固醇诱导的缺血性坏死（AVN）的非骨水泥型全髋关节置换术（THA）设计的中期植入物存活率、失败模式、影像学结果和临床结局。
扫描了2012年1月至2017年11月这5年的时间跨度，以进行5年的随访，共有15例患者（18髋）纳入研究，这些患者接受了超高分子量聚乙烯（UHMWPE）以及新设计的其他股骨头和髋臼内衬组件的植入。本研究仅纳入因类固醇诱导的AVN而接受手术的患者。酒精性、特发性和创伤性AVN患者被排除在研究之外。主要结局指标为Harris髋关节评分（HHS）评估以及是否存在松动、骨溶解、聚乙烯磨损或再次手术（无论是否翻修组件）。根据Engh标准评估非骨水泥型股骨组件的固定情况。
研究组由15例患者的18髋组成。平均年龄为47.6±8.1（29 - 55）岁。所有患者均使用了非骨水泥型股骨干和髋臼杯。1例患者（5.6%）的所有组件均检测到感染性松动。所有患者的平均HHS评分为83.3±7.2（60 - 92）。在18髋中，83%（15髋）、5.6%（1髋）、5.6%（1髋）和5.6%（1髋）的HHS评分分别为良好、差、中等和优秀。所有患者均未检测到陶瓷或聚乙烯内衬磨损。Engh分级量表显示，16髋（89%）出现“骨长入”，1髋（5.6%）出现“疑似长入”，1例感染性松动患者（5.6%）在翻修手术前股骨固定为“欠佳但稳定”。股骨干设计与Engh评分之间无显著相关性（p = 0.842）。
现代全髋关节置换系统，包括陶瓷对陶瓷或陶瓷对聚乙烯的股骨头内衬组合以及非骨水泥型股骨干，为类固醇诱导的AVN治疗提供了有前景的中期存活率和积极的临床结局。然而，需要开展包括更大样本量的长期随访研究以获得更精确的数据。
