Kim Young-Hoo, Park Jang-Won, Jang Young-Soo, Kim Eun-Jung
The Joint Replacement Center of Seoul Metropolitan Government SeoNam Hospital, Seoul, Republic of Korea.
The Joint Replacement Center, Seoul Metropolitan Government SeoNam Hospital, 20, Shinjoung ipen1ro, Yangchun-Gu, Seoul, 08049, Republic of Korea.
Int Orthop. 2025 Jan;49(1):109-116. doi: 10.1007/s00264-024-06367-2. Epub 2024 Nov 18.
We determined long-term (1) clinical results of revision total hip arthroplasty (THA) in the presence of Paprosky type IIIB and IV femoral defects using validated scoring instrument; (2) osseointegration and bone remodeling; (3) the fate of cortical strut onlay allograft; (4) rates of revision and osteolysis; and (5) survivorship of the cementless stem.
We reviewed the results of 240 revision THAs in 220 patients (mean age, 59 years, range, 36-67 years) performed with an extensively porous-coated femoral stem (Solution stem; DePuy, Warsaw, Indiana) combined with a cortical strut onlay allografts for Paprosky Type IIIB and IV femoral diaphyseal bone defects from February 1994 to June 2003. Demographic data, Harris hip score, WOMAC score, UCLA activity score, and radiographic data were recorded. We determined the fate of strut cortical strut allograft and component survival rates at a mean of 26.5 years using revision and aseptic loosening as end points. Minimum follow-up was 21 years (range, 21-30 years).
The clinical results improved significantly for the Harris hip score, WOMAC, and UCLA activity scores (p < 0.001). At the final follow-up, mean Harris hip, WOMAC, and UCLA activity scores were 83 ± 15 (34-100), 20 ± 15 (11-52) and 6.7 ± 1.3 (5-8) points, respectively. Of the 240 femoral stems, 218 (91%) had bone ingrowth, and 22 (9%) were unstable. Allografts were well incorporated in the host femur in all hips. The resorption of allografts was graded as mild in 192 hips (80%) and moderate in 48 hips (20%). A Kaplan-Meier survivorship analysis at a mean of 26.5 years follow-up showed that the survival rate of the femoral component was 91% (95% CI, 0.88-0.96) with re-revision for any reason as the endpoint for failure. The survival rate at a mean of 26.5 years for worst case scenario was 76% (95% CI, 0.71-0.88).
We found good results at a mean of 26.5 years after the revision surgery in terms of longevity and functional outcome using an extensively porous-coated stem combined with cortical strut allografts in the Paprosky Type IIIB and IV femoral diaphyseal defects. We agree that the initial quality of an uncomplicated revision of THA using supportive cortical strut allografts maintains relatively well beyond minimum 21 years of follow-up. Future studies might compare this approach with allograft-prosthesis composites, proximal femoral replacement, or modular fluted tapered stems.
我们使用经过验证的评分工具确定了在存在Paprosky IIIB型和IV型股骨缺损的情况下翻修全髋关节置换术（THA）的长期（1）临床结果；（2）骨整合和骨重塑；（3）皮质支撑层同种异体骨的转归；（4）翻修率和骨溶解率；以及（5）非骨水泥型股骨柄的生存率。
我们回顾了1994年2月至2003年6月期间对220例患者（平均年龄59岁，范围36 - 67岁）进行的240例翻修THA的结果，这些手术使用了广泛多孔涂层的股骨柄（Solution股骨柄；DePuy，印第安纳州华沙）并结合皮质支撑层同种异体骨来处理Paprosky IIIB型和IV型股骨干骨缺损。记录了人口统计学数据、Harris髋关节评分、WOMAC评分、UCLA活动评分和影像学数据。我们以翻修和无菌性松动为终点，在平均26.5年时确定支撑皮质支撑层同种异体骨的转归和假体生存率。最短随访时间为21年（范围21 - 30年）。
Harris髋关节评分、WOMAC评分和UCLA活动评分的临床结果有显著改善（p < 0.001）。在最后随访时，Harris髋关节、WOMAC和UCLA活动评分的平均值分别为83 ± 15（34 - 100）、20 ± 15（11 - 52）和6.7 ± 1.3（5 - 8）分。在240个股骨柄中，218例（91%）有骨长入，22例（9%）不稳定。所有髋关节中的同种异体骨均与宿主股骨良好融合。同种异体骨的吸收在192例髋关节（80%）中为轻度，48例髋关节（20%）中为中度。以平均26.5年的随访进行Kaplan - Meier生存率分析显示，以任何原因再次翻修为失败终点时，股骨假体的生存率为91%（95%可信区间，0.88 - 0.96）。最坏情况时平均26.5年的生存率为76%（95%可信区间，0.71 - 0.88）。
我们发现在翻修手术后平均26.5年时，使用广泛多孔涂层股骨柄并结合皮质支撑层同种异体骨处理Paprosky IIIB型和IV型股骨干缺损，在假体寿命和功能结果方面取得了良好的效果。我们一致认为，使用支撑性皮质支撑层同种异体骨进行的简单THA翻修的初始质量在至少21年的随访后仍保持相对良好。未来的研究可以将这种方法与同种异体骨 - 假体复合物、近端股骨置换或模块化带槽锥形股骨柄进行比较。
