Tapadiya D, Walker R H, Schurman D J
Clin Orthop Relat Res. 1984 Jun(186):5-15.
All patients treated by total hip arthroplasty (THA) from 1971 to 1980 were analyzed to assess cause and rate of revision. Multiparameter radiographic analysis of failed femoral components ( FFC ) and matched control THAs was performed to determine predictability of failure, based on initial postarthroplasty and subsequent follow-up radiographic examinations. Rate of revision for all causes was 10.4% (35 THAs ) for 335 THAs in 270 patients with a follow-up period averaging 5.0 (range, 2-10) years. Cause of revision was component loosening in 7.2% (24 THAs ) [23 (6.9%) with femoral component loosening, 3 (0.9%) progressing to stem fracture, 3 (0.9%) with associated acetabular loosening, and 1 (0.3%) with isolated acetabular loosening]; infection in 1.5% (5 THAs ); and 1.8% (6 THAs ) comprised other causes. Older, inactive women, light in body weight (not including 42 THAs for rheumatoid arthritis), had fewer clinical failures. Second revision rate after revision for component loosening was 29% after an average follow-up period of 3.1 years. Paired comparison of initial postoperative and time-of-failure radiographs of 15 patients with THAs requiring revision for femoral component loosening versus initial postoperative and equivalent follow-up radiographs of 15 age-, sex-, weight-, activity-, diagnosis-, prosthesis-, and follow-up-matched patients with clinically successful THAs revealed the FFC group to be worse with regard to the following parameters: on initial postoperative radiographs, (a) femoral and acetabular bone-cement radiolucency (p less than 0.006 and p less than 0.02, respectively) and (b) when analyzed together, femoral bone-cement radiolucency, calcar-collar contact, femoral metal-cement radiolucency, femoral cement mantle adequacy, cement adequacy distal to the femoral component stem tip, and femoral component stem position (p less than 0.006); and on failure/equivalent radiographs, (a) femoral metal-cement radiolucency (p less than 0.01) and (b) when analyzed together, femoral metal-cement and bone-cement radiolucency, subsidence, cortical hypertrophy, calcar resorption, and sclerosis (p less than 0.006).
对1971年至1980年期间接受全髋关节置换术（THA）治疗的所有患者进行分析，以评估翻修的原因和比例。对失败的股骨组件（FFC）和匹配的对照THA进行多参数影像学分析，根据术后初始及随后的随访影像学检查来确定失败的可预测性。在平均随访5.0年（范围2 - 10年）的270例患者中，335例THA的所有原因导致的翻修率为10.4%（35例THA）。翻修原因包括组件松动7.2%（24例THA）[23例（6.9%）为股骨组件松动，3例（0.9%）进展为柄部骨折，3例（0.9%）伴有髋臼松动，1例（0.3%）为孤立性髋臼松动]；感染1.5%（5例THA）；以及1.8%（6例THA）为其他原因。年龄较大、不活动的体重较轻的女性（不包括42例类风湿性关节炎患者）临床失败较少。组件松动翻修后的二次翻修率在平均随访3.1年后为29%。对15例因股骨组件松动需要翻修的THA患者的术后初始及失败时的X线片与15例年龄、性别、体重、活动、诊断、假体及随访匹配的临床成功的THA患者的术后初始及同等随访X线片进行配对比较，结果显示FFC组在以下参数方面更差：术后初始X线片上，（a）股骨和髋臼骨水泥透亮线（分别为p＜0.006和p＜0.02），以及（b）综合分析时，股骨骨水泥透亮线、小转子 - 假体领接触、股骨金属 - 骨水泥透亮线、股骨水泥套充足性、股骨组件柄尖远端的水泥充足性以及股骨组件柄位置（p＜0.006）；在失败/同等X线片上，（a）股骨金属 - 骨水泥透亮线（p＜0.01），以及（b）综合分析时，股骨金属 - 骨水泥和骨水泥透亮线、下沉、皮质肥大、小转子吸收以及硬化（p＜0.006）。
