Jopek Tomasz, Chodór Paweł, Łapaj Łukasz, Woźniak Waldemar, Michalak Sławomir, Kruczyński Jacek
Department of General Orthopedics, Muskuloskeletal Oncology and Trauma Surgery, Poznan University of Medical Sciences, ul. 28 Czerwca 1956 r 135/147, 60-545 Poznań, Poland.
J Clin Med. 2024 Oct 4;13(19):5921. doi: 10.3390/jcm13195921.
: Stem revisions in revision total hip arthroplasty (THA) with proximal bone stock loss may be dealt with utilizing modular, uncemented conical stems. During stem extraction, surgeons may resort to extended trochanteric osteotomy (ETO). However, ETO is associated with extensive blood loss and infections. This study compared the clinical outcomes, radiographic results and complications in THA revisions utilizing conical modular stem with and without ETO. Patients who underwent revision THA with or without ETO were assessed retrospectively. The minimal follow-up was 3 years. The functional evaluation included Harris Hip Score (HHS) and Short Form 36 (SF-36) as well as Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numerical Rating Scale for pain assessment. The radiographic evaluation comprised bone defect assessment, osteotomy healing, stem migration and position, presence of radiolucent lines and stress shielding. In total, 73 patients (80 hips) were included in the final analysis. The ETO group comprised 48 hips, and the no-ETO group comprised 32 hips. In the ETO group, pre-operative WOMAC scores were lower than in the no-ETO group ( = 0.012). No significant differences were found in terms of post-operative HHS, WOMAC, and NRS scores between groups, except worse results were found in the case of claw plate implantation. Patients in the no-ETO group exhibited better results in SF-36 than in the ETO-group. Osteotomy non-union was observed in four hips (9.5%). Stam varus/valgus position was within ±1.5 degrees (85.9%). ETO does not adversely impact outcomes in patients undergoing femoral stem revisions with modular conical stems. The invasive nature of these procedures prompts careful consideration in each case individually.
在近端骨量丢失的全髋关节置换翻修术（THA）中，可使用模块化、非骨水泥型锥形柄来处理柄的翻修。在柄取出过程中，外科医生可能会采用大转子延长截骨术（ETO）。然而，ETO与大量失血和感染有关。本研究比较了使用和不使用ETO的锥形模块化柄在THA翻修术中的临床结果、影像学结果及并发症。对接受有或无ETO的THA翻修术的患者进行回顾性评估。最短随访时间为3年。功能评估包括Harris髋关节评分（HHS）、简明健康状况调查问卷（SF-36）以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和疼痛评估数字评定量表。影像学评估包括骨缺损评估、截骨愈合情况、柄的移位和位置、透亮线的存在以及应力遮挡。最终分析共纳入73例患者（80髋）。ETO组有48髋，非ETO组有32髋。在ETO组中，术前WOMAC评分低于非ETO组（P = 0.012）。除了在爪形钢板植入的情况下结果较差外，两组之间在术后HHS、WOMAC和NRS评分方面未发现显著差异。非ETO组患者在SF-36方面的结果优于ETO组。在4髋（9.5%）中观察到截骨不愈合。柄内翻/外翻位置在±1.5度以内（85.9%）。ETO对接受模块化锥形柄股骨柄翻修术的患者的结果没有不利影响。这些手术的侵入性促使在每个病例中都要仔细考虑。
