Battaglia Antonino G, D'Apolito Rocco, Ding Benjamin T K, Tonolini Stefano, Ramazzotti Joil, Zagra Luigi
Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
Bone Jt Open. 2025 Feb 13;6(2):186-194. doi: 10.1302/2633-1462.62.BJO-2024-0182.R1.
Revision hip arthroplasty for femoral stem loosening remains challenging due to significant bone loss and deformities requiring specialized revision stems. The aim of this study was to evaluate the clinical and radiological outcomes, and survival, of a consecutive series of femoral revisions performed using a primary cementless stem with tapered geometry and rectangular cross-section at medium-term follow-up.
We retrospectively evaluated 113 patients (115 hips) with intraoperative Paprosky type I (n = 86) or II (n = 29) defects, who underwent femoral revision with Alloclassic Zweymüller SL stem for one-stage aseptic revision or two-stage septic revision from January 2011 to December 2020. The mean follow-up was 77.9 months (SD 33.8). Nine patients were lost to follow-up (deceased or not available), leaving 104 patients (106 hips) for the clinical and radiological analysis. Clinical assessment was performed with Harris Hip Score (HHS) and visual analogue scale (VAS) before surgery and at final follow-up.
There were 60 males and 53 females with a mean age at time of surgery of 71.2 years (SD 12.6). The mean HHS and VAS significantly improved at final follow-up, from 33.7 (SD 13.0) and 5.8 (SD 1.8) preoperatively to 66.4 (SD 16.8) and 2.1 (SD 1.8) postoperatively, respectively (p = 0.001 and p = 0.001). Overall, 28 patients (25%) showed non-progressive radiolucent lines at the level of proximal femur without radiological or clinical signs of loosening. One patient had a recurrence of periprosthetic joint infection after a two-stage procedure requiring re-revision surgery. One patient underwent exchange of modular components for recurrent dislocation, and another case of dislocation was treated conservatively. The survival with aseptic loosening as endpoint was 100%, while stem revision for any reason was 99.1% at up to 152 months' follow-up.
Alloclassic Zweymüller SL primary stem showed favourable medium-term results and survival for revision total hip arthroplasty in Paprosky type I and II defects.
由于存在严重的骨丢失和畸形，需要使用专门的翻修柄，股骨柄松动的髋关节翻修术仍然具有挑战性。本研究的目的是评估在中期随访时，使用具有锥形几何形状和矩形横截面的初次非骨水泥柄进行的一系列连续股骨翻修术的临床和放射学结果以及生存率。
我们回顾性评估了113例患者（115髋），这些患者术中存在Paprosky I型（n = 86）或II型（n = 29）缺损，于2011年1月至2020年12月接受了使用Alloclassic Zweymüller SL柄进行的股骨翻修术，用于一期无菌翻修或二期感染性翻修。平均随访时间为77.9个月（标准差33.8）。9例患者失访（死亡或无法联系），剩余104例患者（106髋）进行临床和放射学分析。术前和末次随访时采用Harris髋关节评分（HHS）和视觉模拟量表（VAS）进行临床评估。
患者中男性60例，女性53例，手术时平均年龄为71.2岁（标准差12.6）。末次随访时，平均HHS和VAS显著改善，术前分别为33.7（标准差13.0）和5.8（标准差1.8），术后分别为66.4（标准差16.8）和2.1（标准差1.8）（p = 0.001和p = 0.001）。总体而言，28例患者（25%）在股骨近端水平出现无松动放射学或临床体征的非进行性透亮线。1例患者在二期手术后假体周围关节感染复发，需要再次翻修手术。1例患者因反复脱位进行了模块化部件更换，另1例脱位病例采用保守治疗。以无菌性松动为终点的生存率为100%，而在长达152个月的随访中，因任何原因进行柄翻修的比例为99.1%。
Alloclassic Zweymüller SL初次柄在Paprosky I型和II型缺损的髋关节翻修术中显示出良好的中期结果和生存率。
