McPherson E J, Dorr L D, Gruen T A, Saberi M T
USC Center for Arthritis and Joint Implant Surgery, USC University Hospital 90033-4634, USA.
Clin Orthop Relat Res. 1995 Jun(315):223-30.
A matched pair study of 2 groups of 42 uncemented total hip replacements were compared retrospectively after a minimum 3-year followup. Forty-two hips were implanted with a hydroxyapatite coating on the proximal femoral patched porous surfaces; 42 hips had patched porous-coated stems without hydroxyapatite. There were no clinical differences between the matched groups by any criteria of measurement. There was no statistically significant difference between the matched groups for femoral stem fixation at all followup intervals. At the 3-year followup, 90% of the femoral stems in the hydroxyapatite porous group, and 83% in the porous control group achieved stable bony fixation. Hydroxyapatite-coated femoral stems demonstrated accelerated bone remodeling characterized by proximal cancellous hypertrophy. The percentage of femoral stems exhibiting cancellous hypertrophy was significantly greater at all followup intervals. This study did not demonstrate any clinical advantage of hydroxyapatite being added to a porous-coated surface. The radiographic changes of bone remodeling seen with hydroxyapatite are not known to improve durability of the hip arthroplasty. This study again condemns the use of patched porous-coating and titanium-bearing surfaces.
对两组各42例非骨水泥型全髋关节置换术进行配对研究，在至少3年的随访后进行回顾性比较。42例髋关节在股骨近端修补的多孔表面植入羟基磷灰石涂层；42例髋关节使用无羟基磷灰石的修补多孔涂层柄。根据任何测量标准，配对组之间均无临床差异。在所有随访间隔中，配对组之间在股骨柄固定方面无统计学显著差异。在3年随访时，羟基磷灰石多孔组中90%的股骨柄和多孔对照组中83%的股骨柄实现了稳定的骨固定。羟基磷灰石涂层股骨柄表现出以近端松质骨肥大为主的加速骨重塑。在所有随访间隔中，表现出松质骨肥大的股骨柄百分比显著更高。本研究未证明在多孔涂层表面添加羟基磷灰石有任何临床优势。羟基磷灰石所见的骨重塑影像学变化是否能提高髋关节置换术的耐用性尚不清楚。本研究再次谴责使用修补多孔涂层和含钛表面。
