Sharkey P F, Barrack R L, Tvedten D E
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
J Arthroplasty. 1998 Aug;13(5):546-51. doi: 10.1016/s0883-5403(98)90054-7.
Thirty-nine uncemented porous-coated long-term stable fixation total hip prostheses with a minimum 5-year follow-up, were retrospectively reviewed for clinical and radiographic outcome. Clinical evaluation was performed using the modified Harris Hip Score. Additionally, all patients completed a satisfaction questionnaire. Anteroposterior view and lateral view radiographs were obtained and compared with immediate postoperative films utilizing the Hip Society radiographic evaluation form for uncemented implants. The follow-up period averaged 69 months (range, 60-87 months). At the most recent follow-up visit Harris Hip Scores averaged 88 points (range, 68-100 points), with 79% good or excellent results. Of the 8 hips (6 patients) with fair or poor results, 5 patients (6 hips) were Charnley category C patients. All patients were satisfied with their surgery and all, but 2 stated that their function had significantly improved. The incidence of significant thigh pain was 13%. Calcar osteolysis was present in 13 of 39 femurs with the majority of cases being minimal. All but one femoral component demonstrated bone ingrowth. There was no distal femoral osteolysis present and no femoral revisions have been performed or are planned. Acetabular osteolysis was present in 7 of 39 hips, with 4 of the 7 centered around acetabular fixation screws. All patients who had acetabular bone loss had some degree of femoral osteolysis. Thus far, one patient has required acetabular revision secondary to osteolysis. Acetabular osteolysis in this series was more profound than on the femoral side and two other patients are being considered for revision due to pelvic side osteolysis. In conclusion, the uncemented long-term stable fixation femoral component proved to be durable in this series of patients. The circumferential porous coating on the femoral implant may protect against distal osteolysis. A concerning rate of severe pelvic osteolysis and impending failure was noted and may lead to a greater need for revision surgery with longer follow-up.
对39例采用非骨水泥多孔涂层且长期稳定固定的全髋关节假体进行回顾性研究，这些患者均有至少5年的随访期，以评估其临床和影像学结果。采用改良Harris髋关节评分进行临床评估。此外，所有患者均完成了一份满意度调查问卷。拍摄前后位和侧位X线片，并使用髋关节协会针对非骨水泥植入物的影像学评估表与术后即刻的片子进行比较。随访期平均为69个月（范围60 - 87个月）。在最近一次随访时，Harris髋关节评分平均为88分（范围68 - 100分），79%的结果为良好或优秀。在结果为一般或较差的8髋（6例患者）中，5例患者（6髋）为Charnley C类患者。所有患者对手术均满意，除2例患者外，其余患者均表示其功能有显著改善。严重大腿疼痛的发生率为13%。39个股骨中有13例存在股骨距骨溶解，大多数病例程度较轻。除1个股骨假体组件外，其余均显示有骨长入。未发现股骨远端骨溶解，且未进行或计划进行股骨翻修手术。39髋中有7髋存在髋臼骨溶解，其中7例中的4例以髋臼固定螺钉为中心。所有发生髋臼骨质流失的患者均有一定程度的股骨骨溶解。迄今为止，有1例患者因骨溶解需要进行髋臼翻修。该系列中的髋臼骨溶解比股骨侧更严重，另外2例患者因骨盆侧骨溶解正在考虑进行翻修。总之，在这一系列患者中，非骨水泥长期稳定固定的股骨组件被证明是耐用的。股骨植入物上的环形多孔涂层可能预防远端骨溶解。注意到严重骨盆骨溶解和即将出现失败的发生率令人担忧，随着随访时间延长，可能导致更大的翻修手术需求。
