Ishii Seiya, Baba Tomonori, Shirogane Yuichi, Hayashi Koju, Homma Yasuhiro, Muto Osamu, Kaneko Kazuo, Ishijima Muneaki
Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan.
Skeletal Radiol. 2025 Mar;54(3):447-455. doi: 10.1007/s00256-024-04756-7. Epub 2024 Jul 25.
The incidence of periprosthetic fractures after total hip arthroplasty using a short tapered-wedge stem is high. Callus formation preceding this fracture, which indicates postoperative stress fracture around the stem, has been reported. However, previous studies on postoperative callus are limited. Hence, the current study aimed to evaluate the prevalence and risk factors of postoperative callus after total hip arthroplasty with a short tapered-wedge stem.
This retrospective study included 127 patients who underwent total hip arthroplasty using a cementless short tapered-wedge stem. The depth of stem insertion was measured as the distance from the lateral corner of the stem to the most medial point of the lesser trochanter along the body axis. Postoperative callus was defined as a bridging callus on the lateral femoral cortex at the distal end of the porous coating of the stem. Plain radiography was performed before surgery and immediately and at 1, 3, and 6 months after surgery to assess postoperative callus. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PC.
In total, 60 (47.2%) of 127 patients presented with postoperative callus. Multivariate logistic regression analysis with postoperative callus as the dependent variable revealed that the stem depth at 1 month after total hip arthroplasty (odds ratio, 1.14; 95% confidence interval, 1.04-1.24, p = 0.002) was a significant and independent risk factor of postoperative callus.
Deep insertion of a short tapered-wedge stem is a risk factor for postoperative callus.
使用短锥形楔形柄进行全髋关节置换术后假体周围骨折的发生率较高。此前已有报道称，在这种骨折之前会有骨痂形成，这表明柄周围存在术后应力性骨折。然而，以往关于术后骨痂的研究有限。因此，本研究旨在评估使用短锥形楔形柄进行全髋关节置换术后骨痂的发生率及危险因素。
这项回顾性研究纳入了127例行非骨水泥型短锥形楔形柄全髋关节置换术的患者。柄的插入深度通过沿着身体轴线测量从柄的外侧角到小转子最内侧点的距离来确定。术后骨痂定义为柄的多孔涂层远端外侧股骨皮质上的桥接骨痂。在手术前、术后即刻以及术后1、3和6个月进行X线平片检查以评估术后骨痂。进行单因素和多因素逻辑回归分析以确定术后骨痂的危险因素。
127例患者中共有60例（47.2%）出现术后骨痂。以术后骨痂为因变量的多因素逻辑回归分析显示，全髋关节置换术后1个月时柄的深度（比值比，1.14；95%置信区间，1.04 - 1.24，p = 0.002）是术后骨痂的一个显著且独立的危险因素。
短锥形楔形柄的深插入是术后骨痂的一个危险因素。
