Metaphyseal Stem Tip Location is a Risk Factor for Aseptic Loosening of Cemented Distal Femoral Replacements.
Metaphyseal Stem Tip Location is a Risk Factor for Aseptic Loosening of Cemented Distal Femoral Replacements.
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DOI：
10.1016/j.arth.2021.04.035
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发表时间：
2021-09
影响因子：
3.5
通讯作者：
Bernthal, Nicholas M.
中科院分区：
文献类型：
--
作者：
Greig, Danielle;Trikha, Rishi;Geiger, Erik J.;Sekimura, Troy;Eckardt, Jeffrey J.;Bernthal, Nicholas M.
关键词：
本研究的目的是描述骨水泥型股骨柄远端股骨置换（DFR）的无菌性松动（AL）发生率，并识别其发展的可修改风险因素。对40年内在一家机构植入的245例连续初次骨水泥型股骨柄DFR进行了回顾性分析。主要结局是AL的翻修手术。进行多变量分析以确定AL的风险因素。审查X线片以确定股骨柄尖端位置，定义为骨干或干骺端。使用Kaplan-Meier分析比较植入物存活率与AL。AL和结构失效是最常见的种植体失效原因（发生率11.8%，29/245）。年龄较小（P = .002）、男性（P = .01）、切除长度较长（P = .04）和非组配式植入物（P = .002）均与AL显著相关。1：1匹配后，干骺端骨中的股骨柄尖端位置与AL独立相关（P = .04）。36%（9/25）松动的植入物的柄头端位于干骺端，而只有8%（2/25）未失效的植入物。30-干骺端股骨柄头端植入物的AL年生存率低于骨干股骨柄头端植入物（22.7% vs 47.6%; P = 0.11）。干骺端骨中的股骨柄尖端位置与AL存活率降低相关。在DFR前进行模板时，股骨柄尖端位置可帮助识别高风险重建，这些重建可能受益于替代或补充固定技术，以防止AL的发展。
The objective of this study was to describe the incidence of aseptic loosening (AL) of cemented stem distal femoral replacements (DFR) and to identify modifiable risk factors for its development. A retrospective review was performed of 245 consecutive primary, cemented stem DFRs implanted at a single institution over a 40-year period. The primary outcome was revision surgery for AL. A multivariate analysis was performed to identify risk factors for AL. Radiographs were reviewed to identify stem tip location, which was defined as diaphyseal or metaphyseal. Implant survival to AL was compared using Kaplan-Meier analysis. AL and structural failure were the most common causes of implant failure (incidence 11.8%, 29/245). Younger age (P = .002), male sex (P = .01), longer resection length (P = .04), and nonmodular implants (P = .002) were all significantly associated with AL. After 1:1 matching, stem tip location in metaphyseal bone was independently associated with AL (P = .04). 36% (9/25) of implants that loosened had a stem tip located in the metaphysis vs only 8% (2/25) of implants that did not fail. 30-year survival to AL was lower for implants with a metaphyseal stem tip than implants with a diaphyseal stem tip (22.7% vs 47.6%; P = .11). A stem tip location in metaphyseal bone is associated with diminished survival to AL. When templating before DFR, stem tip location can assist in identifying high-risk reconstructions that may benefit from alternative or supplemental fixation techniques to prevent the development of AL.
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影响因子：
4.2
作者：
Bus MP;van de Sande MA;Fiocco M;Schaap GR;Bramer JA;Dijkstra PD
通讯作者：
Dijkstra PD
影响因子：
3.5
作者：
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作者：
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通讯作者：
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影响因子：
4.6
作者：
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