Schmalzried T P, Wessinger S J, Hill G E, Harris W H
Harbor-UCLA Medical Center.
J Arthroplasty. 1994 Jun;9(3):235-42. doi: 10.1016/0883-5403(94)90077-9.
One hundred twenty-two primary total hip arthroplasties were followed for an average of 56 months (range, 48-66 months) in which the Harris-Galante (Zimmer, Warsaw, IN) porous ingrowth acetabular component had been press-fit into the innominate bone without screw fixation. There were no acetabular fractures. No socket was revised for loosening and none were radiographically loose. There was no evidence of disruption of the titanium porous mesh. There was no acetabular osteolysis. Compared to the authors' series of primary hip reconstructions using this same prosthesis inserted with line-to-line reaming and screw fixation, the data indicate that the tight peripheral fit associated with the press-fit technique is effective in reducing both the incidence and extent of bone-implant radiolucencies. However, the increased incidence of radiolucencies near the apex of the acetabulum also suggest that initial contact of the porous surface with live acetabular bone at this location is desirable in order to obtain and maintain an optimal bone-implant interface. Additional studies are necessary to further establish the relationship between the initial fit and long-term fixation of cementless acetabular components. Based on the data and other considerations for eliminating both vascular risk and the potential for fretting wear between the screws and shell, the authors recommend press-fitting without screw fixation for this acetabular component in primary cases when anatomy and bone stock permit. Full seating of the component is recommended in order to obtain dome contact.
对122例初次全髋关节置换术患者进行了平均56个月(范围48 - 66个月)的随访,这些患者的Harris-Galante(Zimmer公司,印第安纳州华沙)多孔长入型髋臼组件采用压配方式植入无名骨,未使用螺钉固定。未发生髋臼骨折。没有因松动而翻修髋臼杯的情况,影像学检查也未发现松动。没有证据表明钛质多孔网出现破损。未发现髋臼骨溶解。与作者使用相同假体采用逐行扩髓和螺钉固定进行的初次髋关节重建系列相比,数据表明压配技术所带来的紧密周边贴合在降低骨 - 植入物透亮线的发生率和范围方面是有效的。然而,髋臼顶部附近透亮线发生率的增加也表明,在此位置多孔表面与髋臼活性骨的初始接触是理想的,以便获得并维持最佳的骨 - 植入物界面。需要进一步的研究来进一步确立非骨水泥髋臼组件的初始贴合与长期固定之间的关系。基于这些数据以及消除血管风险和螺钉与髋臼杯之间微动磨损可能性的其他考虑因素,作者建议在初次手术中,当解剖结构和骨量允许时,对该髋臼组件采用无螺钉固定的压配方式。为了实现穹顶接触,建议使组件完全就位。