D'Lima D D, Oishi C S, Petersilge W J, Colwell C W, Walker R H
Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.
Clin Orthop Relat Res. 1998 Mar(348):140-8.
Two series of 100 consecutive primary total hip arthroplasties, each using a single design of noncemented or cemented femoral component (all 28 mm heads), were compared. One cemented and two noncemented stems underwent revision for aseptic loosening. Of unrevised hips, outcome data statistically favored cemented, rather than noncemented, stems. The data for cemented and noncemented stems, respectively, were: An excellent to good result in 97% versus 88%; thigh pain in 3% versus 40%; subsidence in 0% versus 22%; and endosteal cavitation in 6% versus 12%. For patients with 25 unrevised matched pairs, selected by gender, age, diagnosis, and weight, outcome data also statistically favored cemented over noncemented stems, respectively: an excellent or good result in 25 versus 20 hips; thigh pain in two versus eight hips; and subsidence in none versus six hips. Midterm followup data for these concurrent total hip arthroplasty series of a mid 1980s design revealed prevalence of mechanical failure of 1% for cemented stems and 4% for noncemented stems. Corroborating matched pair comparison neutralized selection bias as a causative factor for these differences. These data indicate contemporary cemented femoral stem fixation is superior to second generation noncemented femoral stem fixation. Controlled comparative studies at midterm to long term followup, such as in this report, are needed to define outcome and indications for current third generation noncemented stem fixation.
对两组各100例连续的初次全髋关节置换术进行了比较，每组均采用单一设计的非骨水泥型或骨水泥型股骨假体（均为28mm股骨头）。1例骨水泥型和2例非骨水泥型假体因无菌性松动而进行了翻修。在未翻修的髋关节中，结果数据在统计学上支持骨水泥型假体而非非骨水泥型假体。骨水泥型和非骨水泥型假体的数据分别如下：优良结果的比例为97%对88%；大腿疼痛的比例为3%对40%；下沉的比例为0%对22%；骨内膜空洞形成的比例为6%对12%。对于按性别、年龄、诊断和体重选择的25对未翻修的匹配对患者，结果数据在统计学上也支持骨水泥型假体而非非骨水泥型假体，分别为：25例髋关节结果优良对20例；2例髋关节出现大腿疼痛对8例；0例髋关节下沉对6例。这些20世纪80年代中期设计的同期全髋关节置换系列的中期随访数据显示，骨水泥型假体的机械故障率为1%，非骨水泥型假体为4%。匹配对比较证实消除了选择偏倚这一导致这些差异的因素。这些数据表明，当代骨水泥型股骨柄固定优于第二代非骨水泥型股骨柄固定。需要进行中期至长期随访的对照比较研究，如本报告中的研究，以确定当前第三代非骨水泥型假体固定的结果和适应症。
