Peters C L, Kull L, Jacobs J J, Rosenberg A G, Galante J O
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
J Bone Joint Surg Am. 1997 May;79(5):701-6. doi: 10.2106/00004623-199705000-00009.
The results were reviewed for thirty-seven hips (thirty-five patients) in which a well fixed femoral component that originally had been implanted with use of a so-called first-generation cementing technique was subsequently left in place at the time of revision of the acetabular component without cement. The purpose of the study was to determine the rate of survival of the femoral component and the complications associated with revision of one side of the joint. The femoral components had been in situ for a mean duration of 102 months (range, twelve to 216 months) at the time of the revision of the acetabular component. At the time of follow-up after the revision of the acetabular component, one patient (one femoral component; 3 per cent) had died, twenty-seven femoral components (73 per cent) were in place and radiographically stable, one femoral component had been removed because of infection, six (16 per cent) had been revised because of aseptic loosening, and two (5 per cent) were definitely loose according to radiographic criteria. Excluding the failures and death, the mean duration of follow-up was sixty-five months (range, forty-eight to 121 months). The predicted survival of the femoral component after the revision of the acetabular component was 88 per cent (95 per cent confidence interval, 82 to 94 per cent) at forty-eight months and 78 per cent (95 per cent confidence interval, 67 to 89 per cent) at eighty-eight months. Dislocation occurred in three hips (8 per cent), and a trochanteric non-union occurred in five (14 per cent). The mean rate of linear polyethylene wear did not differ significantly (0.13 as compared with 0.12 millimeter per year; p = 0.74) from that for a comparable group of forty-nine hips that had had a revision of the femoral component without cement and had been followed for a similar duration. The data support the decision to retain a well fixed femoral component that has been implanted with a so-called first-generation cementing technique when the acetabular component subsequently needs a revision. The survival of the femoral component and the risk of associated complications do not appear to be appreciably altered by revision of the other side of the joint.
对37例髋关节（35例患者）的结果进行了回顾，这些患者最初使用所谓的第一代骨水泥技术植入了固定良好的股骨假体，随后在髋臼假体翻修时未使用骨水泥而保留原位。本研究的目的是确定股骨假体的生存率以及与关节一侧翻修相关的并发症。在髋臼假体翻修时，股骨假体在位的平均时间为102个月（范围为12至216个月）。在髋臼假体翻修后的随访时，1例患者（1个股骨假体；3%）死亡，27个股骨假体（73%）在位且影像学稳定，1个股骨假体因感染被取出，6例（16%）因无菌性松动进行了翻修，2例（5%）根据影像学标准确定为松动。排除失败和死亡病例后，平均随访时间为65个月（范围为48至121个月）。髋臼假体翻修后股骨假体在48个月时的预测生存率为88%（95%置信区间为82%至94%），在88个月时为78%（95%置信区间为67%至89%）。3例髋关节（8%）发生脱位，5例（14%）发生转子不愈合。线性聚乙烯磨损的平均速率与一组49例未使用骨水泥翻修股骨假体且随访时间相似的对照组相比，差异无统计学意义（分别为每年0.13与0.12毫米；p = 0.74）。这些数据支持在髋臼假体随后需要翻修时保留使用所谓第一代骨水泥技术植入的固定良好的股骨假体这一决定。关节另一侧的翻修似乎并未明显改变股骨假体的生存率及相关并发症的风险。
