Suominen S, Santavirta S
Department of Surgery, Satakunta Central Hospital, Pori, Finland.
Ann Chir Gynaecol. 1996;85(3):253-62.
Eleven revision total hip replacements (THR) were performed with the use of transfemoral distally fixing stems. Nine Wagner and two Link cementless stems were used. The mean age of the patients was 62 years (range 44-78) and in mean they had undergone 2.4 previous hip operations. The mean follow-up was 43 months in nine patients and two patients had a new revision during the follow-up. The reasons for these revisions were loosening of stems in association with proximal lysis and periprosthetic fracture in eight cases, proximal femoral resection after infection in one case, loosening and deficient proximal bone in one case and proximal intraoperative fracture in a dysplastic hip after previous intertrochanteric osteotomy in one patient. The subsidence of the stem varied from 0 to 40 mm and two stems were revised during the first year because stability was lost due to subsidence. In those nine cases who were not revised the mean Harris hip score was 74 points. The final results were excellent in two, good in three, fair in two and poor in four cases. Our results suggest that revision total hip arthroplasty in cases where the proximal femur is deficient after lysis, old infection or fracture, using a distal load bearing stem gives satisfactory results in more than half of cases.
采用经股骨远端固定柄进行了11例全髋关节翻修置换术（THR）。使用了9个Wagner柄和2个Link非骨水泥柄。患者的平均年龄为62岁（范围44 - 78岁），平均之前接受过2.4次髋关节手术。9例患者的平均随访时间为43个月，2例患者在随访期间进行了再次翻修。这些翻修的原因包括：8例因柄松动伴近端骨质溶解和假体周围骨折；1例因感染后近端股骨切除；1例因柄松动和近端骨质缺损；1例患者既往转子间截骨术后发育不良髋关节术中近端骨折。柄的下沉量为0至40毫米，2个柄在第一年因下沉导致稳定性丧失而进行了翻修。在未进行翻修的9例患者中，Harris髋关节平均评分为74分。最终结果为2例优秀，3例良好，2例一般，4例差。我们的结果表明，对于因骨质溶解、既往感染或骨折导致近端股骨缺损的病例，采用远端负重柄进行全髋关节翻修置换术，超过半数病例可获得满意结果。
