Ilo Kevin, Hallikeri Prith, Naathan Habillan, Van Duren Bernard, Higgins Mark, McNamara Iain, Smith Toby
Elective Orthopaedics, Nottingham University Hospital, Nottingham, UK.
Norfolk and Norwich University Hospital, Norwich, UK.
Arthroplast Today. 2024 Oct 12;30:101504. doi: 10.1016/j.artd.2024.101504. eCollection 2024 Dec.
This systematic review aims to evaluate the effectiveness and safety of custom femoral stems in primary total hip arthroplasty (THA) for patients with secondary osteoarthritis with abnormal hip anatomy.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, databases were systematically searched for studies published on primary THA utilizing custom femoral stems. Inclusion criteria were studies on patients with secondary osteoarthritis receiving custom stems, with outcomes including implant survival, revision rates, and functional scores. Data were extracted from eligible studies, with a focus on overall and cause-specific revision rates.
A total of 689 studies were screened, 13 met the inclusion criteria, encompassing 806 patients and 951 custom THA procedures. The collective follow-up period averaged 11.6 years, with a mean age of 44.6 years. The mean reoperation and revision rates were 6.9% (95% confidence interval [CI]: 3.24-10.13) and 8.25% (95% CI: 4.02-12.47), respectively. The mean intraoperative fracture rate was 3.23% (95% CI: 1.35-5.11), and the mean postoperative leg length discrepancy was 4.25 mm (95% CI: 1.57-6.93). The mean improvement of postoperative Harris Hip Score was 40.32 (range 30-56).
Custom femoral stems in primary THA demonstrate promising results in terms of implant survival and functional outcomes for patients with complex hip anatomy due to secondary osteoarthritis. These findings support the consideration of custom implants as a viable option for this patient demographic, although further research is warranted for long-term outcomes and direct comparisons with standard prostheses.
本系统评价旨在评估定制股骨柄在初次全髋关节置换术（THA）中用于髋关节解剖结构异常的继发性骨关节炎患者的有效性和安全性。
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，系统检索关于使用定制股骨柄进行初次THA的研究发表情况。纳入标准为针对接受定制柄的继发性骨关节炎患者的研究，结局包括植入物生存率、翻修率和功能评分。从符合条件的研究中提取数据，重点关注总体翻修率和特定原因翻修率。
共筛选689项研究，13项符合纳入标准，涉及806例患者和951例定制THA手术。总随访期平均为11.6年，平均年龄为44.6岁。平均再次手术率和翻修率分别为6.9%（95%置信区间[CI]：3.24 - 10.13）和8.25%（95% CI：4.02 - 12.47）。平均术中骨折率为3.23%（95% CI：1.35 - 5.11），平均术后双下肢长度差异为4.25毫米（95% CI：1.57 - 6.93）。术后Harris髋关节评分的平均改善为40.32（范围30 - 56）。
对于因继发性骨关节炎导致髋关节解剖结构复杂的患者，初次THA中使用定制股骨柄在植入物生存率和功能结局方面显示出良好的结果。这些发现支持将定制植入物作为该患者群体的可行选择，尽管对于长期结局以及与标准假体的直接比较仍需要进一步研究。
