Abe Satomi, Inoue Masahiro, Mikami Takashi, Honke Hidefumi, Suzuki Masahiro, Kanno Taiki, Masuda Takeshi
Department of Orthopedic Surgery, Eniwa Hospital, 2-1-1, Koganechuou, Eniwa, Koganechuou, Hokkaido, 061-1449, Japan.
Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, 8-19-1 Nanakuma, Jounan-ku, Fukuoka, 814-0180, Japan.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):29. doi: 10.1007/s00402-024-05640-8.
Fixation and long-term stability of collared, uncemented stems, such as the CORAIL collared stem, in total hip arthroplasty (THA), depend on a strong cancellous bone sleeve and subsequent osseointegration. This study aimed to investigate bone reaction and mid-term outcomes following compaction autologous bone grafting in uncemented stems in primary THA.
This study retrospectively reviewed patients with primary THA using CORAIL collared stem and having ≥ 5 years follow-up. Patients were divided into the bone graft and control groups based on the use of compaction autologous bone grafting. Demographic characteristics, fracture risk, operation time, complications, revisions, and radiologic measures, such as stress shielding and reactive lines were compared between the groups.
A total of 140 cases (85% women, mean age: 63 years, mean follow-up: 72 months) were included. Autologous bone graft was used in 32 (23%) cases. No significant differences in terms of age, sex, diagnoses, follow-up duration, or operation time were observed between the groups. Stress shielding frequency remained stable at 9.4% between 1y and 5y in the bone graft group, but increased from 13.9 to 28.7% in the control group, resulting in the latter having a higher 5-y frequency than the bone graft group (p = 0.0004). Reactive lines increased from 1y to 5y in both groups (bone graft: 6.3-37.5%, p = 0.0015; control: 4.6-26.9%, p < 0.001) with no significant differences between groups. There were no instances of stem subsidence/loosening or stem revision in either group.
Autologous compaction bone grafting achieved satisfactory fixation of the uncemented CORAIL collared stem without requiring distal fixation and mitigated stress shielding. Larger, prospective studies with longer follow-ups are needed to confirm the clinical implications of these mid-term results in primary THA.
在全髋关节置换术（THA）中，带领的非骨水泥型股骨柄（如CORAIL带领股骨柄）的固定及长期稳定性取决于强大的松质骨袖套及随后的骨整合。本研究旨在调查初次全髋关节置换术中非骨水泥型股骨柄采用自体骨打压植骨后的骨反应及中期结果。
本研究回顾性分析了使用CORAIL带领股骨柄且随访时间≥5年的初次全髋关节置换术患者。根据是否使用自体骨打压植骨将患者分为植骨组和对照组。比较两组患者的人口统计学特征、骨折风险、手术时间、并发症、翻修情况以及诸如应力遮挡和反应线等影像学指标。
共纳入140例患者（85%为女性，平均年龄63岁，平均随访72个月）。32例（23%）患者使用了自体骨移植。两组在年龄、性别、诊断、随访时间或手术时间方面未观察到显著差异。植骨组应力遮挡发生率在1年至5年期间保持稳定，为9.4%，而对照组从13.9%增加至28.7%，导致对照组5年时的发生率高于植骨组（p = 0.0004）。两组反应线均从1年至5年增加（植骨组：6.3 - 37.5%，p = 0.0015；对照组：4.6 - 26.9%，p < 0.001），组间无显著差异。两组均未出现股骨柄下沉/松动或股骨柄翻修情况。
自体骨打压植骨实现了非骨水泥型CORAIL带领股骨柄的满意固定，无需远端固定，并减轻了应力遮挡。需要进行更大规模、随访时间更长的前瞻性研究来证实这些中期结果在初次全髋关节置换术中的临床意义。
