Zavras Athan G, Vucicevic Rajko S, Fice Michael P, Yu Austin, Khan Zeeshan A, Dandu Navya, Blank Alan T, Gitelis Steven, Levine Brett R, Colman Matthew W
Department of Orthopaedic Surgery, Allegheny General Hospital, 1307 Federal St, Pittsburgh, PA, 1512, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL, 60612, USA.
J Orthop. 2024 Jul 17;59:36-40. doi: 10.1016/j.jor.2024.07.014. eCollection 2025 Jan.
Proximal femoral replacement (PFR) is a reconstruction technique after tumor resection or for revision of failed total hip arthroplasty (THA). However, despite acceptable long-term oncologic and functional outcomes, extensive soft tissue or bone loss increases the risk for prosthetic instability. Instability may depend on the construct chosen for reconstruction, with current options including bipolar, constrained, or dual mobility implants. Clinical studies comparing patient outcomes after PFR with these three different constructs are limited.
This study retrospectively examined a single tertiary academic institution's experience with PFR over a fifteen-year period. The medical records of patients who underwent PFR for indications such as tumor and failed THA with bone loss were reviewed. Patients were stratified into cohorts based on use of bipolar, constrained, or dual mobility implants. Patient demographics, disease characteristics, perioperative data, and data on prosthetic dislocations were recorded. ANOVA and chi-square testing was performed for continuous and categorical variables, respectively. The threshold for statistical significance was set to p < 0.05.
106 patients were identified who underwent PFR. 46 underwent PFR with bipolar prosthesis (follow-up: 20 ± 24.57 months), 42 with constrained liner (follow-up: 30.45 ± 35.32 months), and 18 with dual mobility (follow-up: 15.38 ± 15.67 months). Only BMI (p = 0.036) and smoking history ( = 0.002) differed between groups. Dislocations occurred in 4 (8.7 %) patients who underwent reconstruction with bipolar prosthesis, compared to 8 (19.0 %) with constrained liner, and 3 (16.7 %) patients with dual mobility. Mean time to dislocation was significantly longer in dual mobility patients ( = 0.009). There were no differences in instances of early dislocation between groups ( = 00.238).
While study numbers are low, mean time to dislocation was significantly longer with dual mobility. Additional large-scale longitudinal studies are needed to fully elucidate the differences in outcomes amongst these three treatments.
股骨近端置换术（PFR）是肿瘤切除术后或全髋关节置换术（THA）失败翻修的一种重建技术。然而，尽管长期肿瘤学和功能结果尚可，但广泛的软组织或骨丢失会增加假体不稳定的风险。不稳定可能取决于所选的重建结构，目前的选择包括双极、限制性或双动式植入物。比较PFR术后这三种不同结构患者预后的临床研究有限。
本研究回顾性分析了一家三级学术机构15年间PFR的经验。回顾了因肿瘤和THA失败伴骨丢失等适应症接受PFR的患者的病历。根据双极、限制性或双动式植入物的使用情况将患者分层。记录患者的人口统计学、疾病特征、围手术期数据和假体脱位数据。分别对连续变量和分类变量进行方差分析和卡方检验。统计学显著性阈值设定为p < 0.05。
共确定106例接受PFR的患者。46例采用双极假体进行PFR（随访：20 ± 24.57个月），42例采用限制性衬垫（随访：30.45 ± 35.32个月），18例采用双动式（随访：15.38 ± 15.67个月）。各组之间仅BMI（p = 0.036）和吸烟史（p = 0.002）存在差异。双极假体重建的患者中有4例（8.7%）发生脱位，采用限制性衬垫的患者中有8例（19.0%），采用双动式的患者中有3例（16.7%）。双动式患者脱位的平均时间显著更长（p = 0.009）。各组早期脱位情况无差异（p = 0.238）。
虽然研究样本量较小，但双动式脱位的平均时间显著更长。需要更多大规模的纵向研究来充分阐明这三种治疗方法在预后方面的差异。
