Poon E D, Lachiewicz P F
Department of Orthopaedics, University of North Carolina, Chapel Hill, USA.
J Arthroplasty. 1998 Jan;13(1):42-9. doi: 10.1016/s0883-5403(98)90074-2.
Controversy exists over whether to remove a well-fixed femoral component at the time of revision of a failed acetabular component, and it has been suggested that the femoral component be removed and recemented. The hypothesis presented in this article is that only the acetabular component should be revised in these situations. Thirty-eight isolated, uncemented acetabular revisions were performed by 1 surgeon and prospectively followed for a mean of 4 years (range, 2-10 years). The femoral component was well fixed at the time of revision and left in situ. There were 30 cemented and 8 uncemented femoral components, which had been in place for a mean of 10.7 years. The hips were evaluated clinically using the Harris hip score rating system. Radiographic evaluation of both components was performed using well-established criteria. Morselized cancellous allograft was used to fill acetabular defects in 30 hips, and a bulk allograft was used in 1 hip. There was a good or excellent clinical result in 32 hips (84%). Two cemented femoral components required revision for aseptic loosening at 2.5 and 4 years. No acetabular component migrated or was revised, and no revisions of either component are pending. Thirty-six (95%) of the unrevised femoral components remain well fixed at the most recent follow-up examination. Compared with a similar population of hips in which both the acetabular and femoral components were revised, the mean blood loss for these revisions was 52% less and the mean surgical time was 35% shorter. Revision of only the acetabular component is recommended for isolated acetabular aseptic loosening. Because the femoral component is not removed, surgical time and blood loss are decreased and serious potential complications related to removing a well-fixed femoral component can be avoided.
在翻修失败的髋臼假体时是否移除固定良好的股骨假体存在争议，有人建议移除股骨假体并重新植入骨水泥。本文提出的假设是，在这些情况下仅应翻修髋臼假体。一位外科医生对38例孤立的非骨水泥髋臼翻修手术进行了前瞻性研究，平均随访4年（范围为2至10年）。翻修时股骨假体固定良好，予以保留。有30例股骨假体植入了骨水泥，8例未植入骨水泥，平均在位时间为10.7年。采用Harris髋关节评分系统对髋关节进行临床评估。使用既定标准对两个假体进行影像学评估。30例髋关节使用颗粒状松质骨同种异体骨填充髋臼缺损，1例髋关节使用整块同种异体骨。32例髋关节（84%）临床结果为良好或优秀。2例植入骨水泥的股骨假体分别在2.5年和4年因无菌性松动需要翻修。没有髋臼假体发生移位或需要翻修，且两个假体均无待翻修情况。在最近一次随访检查中，36例（95%）未翻修的股骨假体仍固定良好。与髋臼和股骨假体均进行翻修的类似髋关节人群相比，这些翻修手术的平均失血量减少了52%，平均手术时间缩短了35%。对于孤立的髋臼无菌性松动，建议仅翻修髋臼假体。由于不移除股骨假体，手术时间和失血量减少，并且可以避免与移除固定良好的股骨假体相关的严重潜在并发症。
