Nasser Ahmed Abdul Hadi Harb, Gavvala Sai Niharika, Shirodkar Kapil, Botchu Rajesh
The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.
Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.
J Clin Med. 2025 Sep 6;14(17):6300. doi: 10.3390/jcm14176300.
The indications for femoral endoprosthesis replacement (EPR) use in limb reconstruction have broadened over the last decade. Despite its success, loosening remains the most common reason for failure. No previous system has classified loosening based on the anatomical site in relation to the prosthesis. The aim of this study is to propose a simple reproducible classification system for EPR loosening. Adult patients that underwent a revision EPR for loosening from 1 January 2023-1 May 2025 were included. Radiographs and computed tomography (CT) images were retrospectively reviewed. The grading was developed on radiographs to classify loosening around EPRs as normal (grade 1), loosening at the shoulder (grade 2), loosening around the shaft of the peg (grade 3), loosening below the tip of the prosthesis (grade 4), associated penetration of prosthesis through the cortex (grade 5), and associated fracture (grade 6). A total of 28 patients were included. The majority of patients were male (n = 17; 61%) with a mean age of 50.6 years (SD 16.1). The average time from the index surgery to diagnosis of loosening was 10.1 years (SD 7.6). The most common pattern of loosening was grade 3 (N = 16; 57.1%). Our classification system proposes an easily adopted way to describe all patterns of loosening around EPRs, potentially guiding revision surgical strategies. Standardizing the approach in evaluating loosening will aid in producing national guidelines for managing this complex complication and may help improve future EPR design.
在过去十年中，用于肢体重建的股骨假体置换术（EPR）的适应证有所拓宽。尽管取得了成功，但松动仍然是最常见的失败原因。以前没有任何系统根据与假体相关的解剖部位对松动进行分类。本研究的目的是提出一种简单且可重复的EPR松动分类系统。纳入了2023年1月1日至2025年5月1日因松动而接受EPR翻修手术的成年患者。对X线片和计算机断层扫描（CT）图像进行了回顾性分析。在X线片上制定分级标准，将EPR周围的松动分为正常（1级）、肩部松动（2级）、钉杆周围松动（3级）、假体尖端以下松动（4级）、假体穿透皮质（5级）和伴有骨折（6级）。共纳入28例患者。大多数患者为男性（n = 17；61%），平均年龄50.6岁（标准差16.1）。从初次手术到诊断为松动的平均时间为10.1年（标准差7.6）。最常见的松动类型为3级（N = 16；57.1%）。我们的分类系统提出了一种易于采用的方法来描述EPR周围所有的松动模式，可能为翻修手术策略提供指导。规范评估松动的方法将有助于制定处理这种复杂并发症的国家指南，并可能有助于改进未来的EPR设计。
