Xenos J S, Callaghan J J, Heekin R D, Hopkinson W J, Savory C G, Moore M S
Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
J Bone Joint Surg Am. 1999 Jan;81(1):74-82. doi: 10.2106/00004623-199901000-00011.
One hundred consecutive primary total hip arthroplasties performed with use of a porous-coated anatomic total hip prosthesis, fixed without cement, in ninety-one patients were followed prospectively for a minimum of ten years. At the time of the most recent follow-up, twenty patients (twenty-three hips) had died and seventy-one patients (seventy-seven hips) were living. The average age of the living patients was sixty-six years (range, thirty-two to ninety-two years), and their average Harris hip score was 84 points (range, 33 to 100 points). Twelve percent (nine) of the seventy-seven hips were found to be associated with pain in the thigh when the patients were specifically questioned by the examiner. Eleven hips were revised during the follow-up period. Only the acetabular component was revised in six hips, only the femoral component was revised in one hip, and both the femoral and the acetabular components were revised in four hips. Of the ten acetabular revisions, one was performed because of acute dissociation of the component and eight, because of a combination of polyethylene wear, osteolysis, and loosening; the tenth acetabular revision consisted of exchange of the liner and curettage and bone-grafting of the osteolytic area. Of the five femoral revisions, two were performed because of loosening and three, because of extensive osteolysis of the proximal aspect of the femur. Including the revised components, twelve acetabular components and five femoral components had radiographic evidence of aseptic loosening. Acetabular osteolysis occurred in seventeen hips. Femoral osteolysis occurred in thirty-nine hips: in the proximal aspect of thirty-one hips, in the distal aspect of four, and in both the proximal and the distal aspect of four. The durability of the femoral fixation documented in this study is especially encouraging in view of the fact that this was our initial experience with devices fixed without cement and that a so-called first-generation femoral component was used. However, the study also demonstrated that not all acetabular components fixed without cement function well over the long term and that specific design considerations (adequate initial fixation, congruency between the liner and the shell, an optimum shell-liner capturing mechanism, and a smaller femoral head) are warranted.
对91例患者使用多孔涂层解剖型全髋关节假体进行的100例初次无水泥固定全髋关节置换术进行了至少10年的前瞻性随访。在最近一次随访时，20例患者（23髋）已死亡，71例患者（77髋）仍存活。存活患者的平均年龄为66岁（范围32至92岁），其平均Harris髋关节评分为84分（范围33至100分）。在检查者对患者进行专门询问时，发现77髋中有12%（9髋）与大腿疼痛有关。随访期间有11髋进行了翻修。6髋仅翻修了髋臼组件，1髋仅翻修了股骨组件，4髋同时翻修了股骨和髋臼组件。在10例髋臼翻修中，1例是因为组件急性分离，8例是因为聚乙烯磨损、骨溶解和松动的综合原因；第10例髋臼翻修包括更换内衬以及对骨溶解区域进行刮除和植骨。在5例股骨翻修中，2例是因为松动，3例是因为股骨近端广泛骨溶解。包括翻修的组件在内，12个髋臼组件和5个股骨组件有无菌性松动的影像学证据。髋臼骨溶解发生在17髋。股骨骨溶解发生在39髋：31髋发生在近端，4髋发生在远端，4髋近端和远端均有。鉴于这是我们对无水泥固定装置的初次经验且使用的是所谓第一代股骨组件，本研究中记录的股骨固定耐久性尤其令人鼓舞。然而，该研究也表明，并非所有无水泥固定的髋臼组件长期功能都良好，特定的设计考虑因素（充分的初始固定、内衬与髋臼杯之间的一致性、最佳的髋臼杯 - 内衬固定机制以及较小的股骨头）是必要的。
