Piston R W, Engh C A, De Carvalho P I, Suthers K
Orthopaedic Research Institute, Arlington, Virginia 22206.
J Bone Joint Surg Am. 1994 Feb;76(2):202-14. doi: 10.2106/00004623-199402000-00006.
With use of porous-coated implants, total hip arthroplasty was performed in a consecutive series of thirty patients (thirty-five hips) who had a preoperative diagnosis of late-stage (Ficat and Arlet stage-III or IV) osteonecrosis of the femoral head. The patients were evaluated clinically and radiographically, and the data were recorded in a prospective manner. The average duration of follow-up was seven and one-half years (range, five to ten years). The average age of the patients at the time of the operation was thirty-two years (range, twenty-one to forty years). Signs of osseointegration of the femoral stem to the host bone were demonstrated in thirty-three hips (94 per cent). In the porous-coated hemispherical acetabular cups of these hips, an optimum bone-implant interface was identified and maintained, suggesting bone ingrowth. The rate of revision was 3 per cent (one hip) for the femoral side and 6 per cent (two hips) for the acetabular side, for an over-all rate of 6 per cent. All patients maintained a high level of activity postoperatively. There was moderate or severe remodeling of proximal femoral resorptive bone and stress-shielding in six hips (17 per cent) and osteolytic reactions in six hips. Complications were frequent (six hips) and included one deep infection; two dislocations; two instances of heterotopic ossification; and one fracture of the calcar femorale, which occurred intraoperatively. The thirty patients had a lower rate of revision and improved clinical outcomes compared with other reported series of young patients managed with total hip arthroplasty with cement who had the same diagnosis and similar postoperative follow-up. However, the latter series involved implants of an earlier design that had been inserted with older techniques of cementing. When arthroplasty is considered for the treatment of late-stage osteonecrosis of the femoral head in young patients, the use of total hip implants without cement that allow for bone ingrowth appears to be a viable alternative to arthroplasty with use of cement. However, longer follow-up is needed to determine the outcome of the osteolytic reactions that we observed. We therefore recommend this procedure with some caution because of the high rate of complications and the potential for failure of the arthroplasty related to the osteolytic reactions.
使用多孔涂层植入物，对连续30例（35髋）术前诊断为晚期（Ficat和Arlet III期或IV期）股骨头坏死的患者进行了全髋关节置换术。对患者进行了临床和影像学评估，并以前瞻性方式记录数据。平均随访时间为7.5年（范围为5至10年）。手术时患者的平均年龄为32岁（范围为21至40岁）。33髋（94%）显示股骨柄与宿主骨有骨整合迹象。在这些髋的多孔涂层半球形髋臼杯中，确定并维持了最佳的骨-植入物界面，提示有骨长入。股骨侧的翻修率为3%（1髋），髋臼侧为6%（2髋），总体翻修率为6%。所有患者术后均保持较高的活动水平。6髋（17%）出现股骨近端吸收性骨的中度或重度重塑和应力遮挡，6髋出现骨溶解反应。并发症常见（6髋），包括1例深部感染；2例脱位；2例异位骨化；1例股骨距骨折，发生在术中。与其他报道的诊断相同且术后随访相似的接受骨水泥全髋关节置换术的年轻患者系列相比，这30例患者的翻修率较低，临床结果有所改善。然而，后一系列涉及早期设计的植入物，采用的是较旧的骨水泥固定技术。当考虑对年轻患者的晚期股骨头坏死进行关节置换术时，使用允许骨长入的无骨水泥全髋关节植入物似乎是骨水泥关节置换术的可行替代方案。然而，需要更长时间的随访来确定我们观察到的骨溶解反应的结果。因此，由于并发症发生率高以及与骨溶解反应相关的关节置换术失败的可能性，我们建议谨慎采用该手术方法。
