Mulliken B D, Nayak N, Bourne R B, Rorabeck C H, Bullas R
University Hospital London, Ontario, Canada.
J Arthroplasty. 1996 Jan;11(1):24-33. doi: 10.1016/s0883-5403(96)80158-6.
In a randomized clinical trial of cemented and cementless total hip arthroplasty, 147 patients (76 cemented, 71 cementless) have had a minimum 4-year clinical and radiographic follow-up evaluation. No revisions have been done in either group. Two cemented acetabular components were considered definitely loose and 18 were probably loose; 7 cemented stems were possibly loose at last follow-up examination. One cementless socket was considered unstable. Although cementless femoral component subsidence occurred in 10 cases, the sinkage always stabilized within 6 months, and no stem was considered unstable at last follow-up examination. Significant femoral bone resorption was rare, and so-called "spot welds" were uncommon using this titanium stem. Distal cortical hypertrophy was common, but the cause is uncertain. Osteolysis was seen around 10 cementless and 6 cemented sockets. A small area of lysis occurred in the proximal medial femoral neck in 15 cemented stems and 1 cementless stem. No cases of distal femoral lysis were seen in either group. Despite excellent clinical results with no difference between groups, the high rate of early radiographic failure of this metal-backed acetabulum should preclude its use. Osteolysis will continue to be a problem in both groups, and its prevention should remain the focus of future studies.
在一项关于骨水泥型和非骨水泥型全髋关节置换术的随机临床试验中，147例患者（76例骨水泥型，71例非骨水泥型）接受了至少4年的临床和影像学随访评估。两组均未进行翻修手术。2个骨水泥型髋臼假体被明确认为松动，18个可能松动；在最后一次随访检查时，7个骨水泥型股骨柄可能松动。1个非骨水泥型髋臼杯被认为不稳定。虽然10例出现了非骨水泥型股骨假体下沉，但下沉总是在6个月内稳定下来，在最后一次随访检查时没有股骨柄被认为不稳定。明显的股骨骨质吸收很少见，使用这种钛制股骨柄时所谓的“点焊”也不常见。远端皮质肥大很常见，但原因尚不确定。在10个非骨水泥型和6个骨水泥型髋臼杯周围可见骨溶解。15个骨水泥型股骨柄和1个非骨水泥型股骨柄在股骨近端内侧颈出现小面积溶解。两组均未见到股骨远端溶解病例。尽管临床结果良好且两组之间无差异，但这种金属背衬髋臼早期影像学失败率高，应避免使用。骨溶解在两组中仍将是一个问题，其预防仍应是未来研究的重点。
