Dombrowsky Alex R, Jolissaint Josef E, Avercamp Ben J, Rowe Taylor M, Hietpas Kayla T, Griffin William L, Curtin Brian M
Department of Orthopedics, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.
OrthoCarolina Research Institute, Charlotte, North Carolina.
J Arthroplasty. 2025 Sep;40(9S1):S436-S441. doi: 10.1016/j.arth.2025.05.023. Epub 2025 May 13.
An abundance of literature exists assessing outcomes of revision total hip arthroplasty (THA) using diaphyseal-engaging stems; however, there is little research into the use of primary-style femoral stems in revision THA. Primary stems may have benefits, including cost reduction, maintenance of proximal bone stock, and ease of potential future reconstructions. The purpose of this study was to evaluate the aseptic survival rate of revision THAs using primary femoral stems.
A review of our registry was performed to identify patients from 2010 to 2020 who underwent all-cause revision THA utilizing a primary metaphyseal-engaging stem for femoral reconstruction. Patients who had a history of previous revision THA or those treated with cement or bone graft augmentation were excluded. There were seven patients excluded due to a lack of 2-year follow-up. Implant survival, complications requiring revision surgery, and ambulatory status at final follow-up were documented. There were 78 patients who met the final inclusion criteria. The mean follow-up was 5.2 years (range, 2.0 to 10.0).
The most common indications for index revision were aseptic loosening (44%) or infection (34%). Prerevision Paprosky classification of the femur was Type I in 41 patients (52%), Type II in 37 patients (47%), and Type IIIA in one patient (1%). Overall, 13 patients (16.5%) required rerevision, five for periprosthetic fracture, six for instability, and two for recurrent infection. Of those, seven of 13 required femoral component revision. When excluding recurrent infections, the aseptic femoral component survivorship for the cohort was 94%. There were three patients who sustained a fracture requiring stem rerevision. A Vancouver B1 fracture was sustained > 2 years postoperatively, and two Vancouver B2 fractures were sustained within 6 months postoperatively. There were no femoral rerevisions for aseptic loosening.
Primary metaphyseal-engaging femoral stems provide reliable fixation during revision THA in patients who have preserved proximal metaphyseal bone, with similar complication rates to those previously reported in the literature for revision THA.
现有大量文献评估使用骨干固定柄进行翻修全髋关节置换术（THA）的结果；然而，对于在翻修THA中使用初次置换型股骨干的研究较少。初次置换柄可能具有一些益处，包括降低成本、保留近端骨量以及便于未来可能的翻修。本研究的目的是评估使用初次置换股骨干的翻修THA的无菌生存率。
对我们的登记数据库进行回顾，以确定2010年至2020年间因各种原因接受翻修THA并使用初次置换型干骺端固定柄进行股骨重建的患者。排除既往有翻修THA病史或接受骨水泥或植骨增强治疗的患者。因缺乏2年随访而排除7例患者。记录植入物生存率、需要翻修手术的并发症以及最后随访时的活动状态。共有78例患者符合最终纳入标准。平均随访时间为5.2年（范围2.0至10.0年）。
初次翻修的最常见指征是无菌性松动（44%）或感染（34%）。翻修前股骨的Paprosky分类为I型41例（52%），II型37例（47%），IIIA型1例（1%）。总体而言，13例患者（16.5%）需要再次翻修，5例因假体周围骨折，6例因不稳定，2例因反复感染。其中，13例中有7例需要翻修股骨组件。排除反复感染后，该队列的无菌股骨组件生存率为94%。有3例患者发生骨折需要再次翻修柄。1例温哥华B1型骨折发生在术后2年以上，2例温哥华B2型骨折发生在术后6个月内。没有因无菌性松动而进行股骨再次翻修的情况。
对于保留近端干骺端骨的患者，初次置换型干骺端固定股骨干在翻修THA期间提供可靠的固定，并发症发生率与先前文献报道的翻修THA相似。
