Ochi Hironori, Baba Tomonori, Nozawa Masahiko, Kato Suguru, Sasaki Kyoko, Sakamoto Yuko, Kim Sung-Gon, Ishijima Muneaki
Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan.
Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
SICOT J. 2025;11:29. doi: 10.1051/sicotj/2025024. Epub 2025 May 12.
Complications on the femoral side after performing proximal femoral replacement (PFR), such as stem loosening and periprosthetic fractures, are the major reasons for reoperation. Femoral reconstruction was performed using PFR with a locking plate to minimize the risk of complications. We present the case of an 85-year-old woman with stem loosening and massive proximal femoral bone loss (Paprosky type IV) 10 years after stem revision in bipolar hemiarthroplasty. Femoral reconstruction was performed using the following surgical techniques. After removing the previous implant, a PFR was inserted into the host bone of the distal femur and fixed at the junction with cement. In addition, a locking plate was used for bridging. Full weight-bearing rehabilitation was started the day after surgery. At the 5-year follow-up, the patient could walk steadily without complications. A postoperative radiograph of the femur showed no signs of a radiolucent line, implant-related issues, or bone resorption. This reconstructive technique may reduce the high torsional and compressive stresses on bone cement prostheses, which can cause complications on the femoral side. Even in the case of poor femoral host bone quality, this reconstruction method can achieve robust femoral reconstruction. Femorl reconstruction using PFR with a locking plate is a particularly beneficial reconstruction method for older patients with massive proximal femoral bone loss.
进行股骨近端置换（PFR）后股骨侧的并发症，如柄松动和假体周围骨折，是再次手术的主要原因。采用带锁定钢板的PFR进行股骨重建，以尽量降低并发症风险。我们报告一例85岁女性病例，在双极半髋关节置换术柄翻修10年后出现柄松动和大量股骨近端骨丢失（Paprosky IV型）。采用以下手术技术进行股骨重建。取出先前的植入物后，将一个PFR插入股骨远端的宿主骨并在结合处用骨水泥固定。此外，使用锁定钢板进行桥接。术后第一天开始进行完全负重康复。在5年随访时，患者能够平稳行走且无并发症。术后股骨X线片显示无透亮线、植入物相关问题或骨吸收迹象。这种重建技术可能会降低骨水泥假体上的高扭转和压缩应力，而这些应力可导致股骨侧并发症。即使在股骨宿主骨质量较差的情况下，这种重建方法也能实现稳固的股骨重建。使用带锁定钢板的PFR进行股骨重建对于有大量股骨近端骨丢失的老年患者是一种特别有益的重建方法。
