Yamate Satoshi, Hamai Satoshi, Konishi Toshiki, Nakao Yuki, Kawahara Shinya, Hara Daisuke, Motomura Goro, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Bone Jt Open. 2024 Oct 11;5(10):858-867. doi: 10.1302/2633-1462.510.BJO-2024-0144.R1.
The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.
We included patients who underwent THA using Wagner Cone due to proximal femur anatomical abnormalities between August 2014 and January 2019 at a single institution. We investigated implant survival time using the endpoint of dislocation and revision, and compared the prevalence of prosthetic impingements between the Wagner Cone, a tapered cone stem, and the Taperloc, a tapered wedge stem, through simulation. We also collected Oxford Hip Score (OHS), visual analogue scale (VAS) satisfaction, and VAS pain by postal survey in August 2023 and explored variables associated with those scores.
Of the 58 patients (62 hips), two (two hips) presented with dislocation or reoperation, and Kaplan-Meier analysis indicated a five-year survival rate of 96.7% (95% CI 92.4 to 100). Mean stem anteversion was 35.2° (SD 18.2°) for the Taperloc stem and 29.8° (SD 7.9°) for the Wagner Cone stem; mean reduction from Taperloc to Wagner Cone was 5.4° (SD 18.8°). Overall, 55 hips (52 patients) were simulated, and the prevalence of prosthetic impingement was lower for the Wagner Cone (5.5%, 3/55) compared with the Taperloc (20.0%, 11/55) stem, with an odds ratio of 0.20 (p = 0.038). Among the 33 respondents to the postal survey (36 hips), the mean scores were VAS pain 10.9, VAS satisfaction 86.9, and OHS 44.7. A multivariable analysis revealed that reduction of stem anteversion from Taperloc to Wagner Cone was more favourable for VAS pain (p = 0.029) and VAS satisfaction (p = 0.002).
The mid-term survival rate for THA using the Wagner Cone stem was high, which may be supported by a reduction in prosthetic impingement. The reduction in excessive stem anteversion by using a tapered cone stem was associated with reduced pain and increased patient satisfaction.
本研究旨在评估锥形柄在全髋关节置换术（THA）中对股骨前倾过大患者及股骨截骨术后患者的适用性。
我们纳入了2014年8月至2019年1月期间在单一机构因股骨近端解剖异常接受使用瓦格纳锥（Wagner Cone）进行THA的患者。我们以脱位和翻修为终点调查植入物存活时间，并通过模拟比较瓦格纳锥（一种锥形柄）和锥形楔形柄Taperloc之间假体撞击的发生率。我们还在2023年8月通过邮寄调查问卷收集了牛津髋关节评分（OHS）、视觉模拟量表（VAS）满意度和VAS疼痛情况，并探索与这些评分相关的变量。
58例患者（62髋）中，2例（2髋）出现脱位或再次手术，Kaplan-Meier分析表明五年生存率为96.7%（95%CI 92.4至100）。Taperloc柄的平均柄前倾角度为35.2°（标准差18.2°），瓦格纳锥柄为29.8°（标准差7.9°）；从Taperloc到瓦格纳锥的平均减小角度为5.4°（标准差18.8°）。总体而言，对55髋（52例患者）进行了模拟，与Taperloc柄（20.0%，11/55）相比，瓦格纳锥柄的假体撞击发生率更低（5.5%，3/55），优势比为0.20（p = 0.038）。在邮寄调查问卷的33名受访者（36髋）中，平均评分分别为VAS疼痛10.9、VAS满意度86.9和OHS 44.7。多变量分析显示，从Taperloc到瓦格纳锥柄的柄前倾角度减小对VAS疼痛（p = 0.029）和VAS满意度（p = 0.002）更有利。
使用瓦格纳锥柄进行THA的中期生存率较高，这可能得益于假体撞击的减少。使用锥形柄减少过度的柄前倾与疼痛减轻和患者满意度提高相关。
