Comparison of Bone Remodeling Between an Anatomic Short Stem and a Straight Stem in 1-Stage Bilateral Total Hip Arthroplasty
Comparison of Bone Remodeling Between an Anatomic Short Stem and a Straight Stem in 1-Stage Bilateral Total Hip Arthroplasty
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DOI：
10.1016/j.arth.2016.07.016
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发表时间：
2017-02-01
影响因子：
3.5
通讯作者：
Okawa, Atsushi
中科院分区：
文献类型：
--
作者：
Koyano, Gaku;Jinno, Tetsuya;Okawa, Atsushi
背景：发育不良髋的股骨表现出特定的异常，建议使用模块化或特殊设计的组件。以前专门设计了一种解剖短柄，用于利用从发育不良患者获得的三维数据来治疗发育不良的髋关节。为了研究骨柄几何形状对骨重塑的影响，我们对接受一期双侧全髋关节置换术（THA）的患者进行了前瞻性随机研究，其中一侧解剖短柄，另一侧为传统直柄。方法：本研究包括36例接受上述THA手术的患者。在平均随访9.2年的基础上，我们根据格伦区和新定义的等间隔区分析，评估了骨密度以及由于应力屏蔽导致的松质凝结或骨萎缩的存在。结果：所有骨根均向内生长稳定。松质凝结在更近端观察到，骨萎缩区域在解剖短茎侧比在直茎侧更窄。骨密度值反映了松质凝结和应力屏蔽的结果，解剖上短茎侧的近端区域比直茎侧的近端区域高。结论：尽管影像学结果显示双茎全髋关节置换术的中期预后良好，但负荷模式有所不同。解剖短柄在近端固定和负荷转移方面达到了设计目的，并更好地保护了股骨近端。(C) 2016 Elsevier Inc.版权所有。
Background: Femurs of dysplastic hips exhibit specific abnormalities, and use of modular or specially designed components is recommended. An anatomic short stem was previously designed specifically for dysplastic hips using 3-dimensional data acquired from dysplastic patients. To investigate effects of stem geometry on bone remodeling, we undertook a prospective, randomized study of patients who had undergone 1-stage bilateral total hip arthroplasty (THA) with the anatomic short stem on one side and a conventional straight stem on the other.Methods: The study included 36 patients who underwent the above THA procedure. We assessed bone mineral density as well as the presence of cancellous condensation or bony atrophy due to stress shielding based on the analysis of Gruen's zones and newly defined equal-interval zones, at an average follow-up period of 9.2 years.Results: All stems were bone ingrown stable. Cancellous condensation was observed more proximally, and areas of bone atrophy were narrower on the anatomic short stem side than on the straight stem side. Bone mineral density values reflected results of cancellous condensation and stress shielding and were higher in more proximal zones on the anatomic short stem side than on the straight stem side.Conclusion: Although radiographic results indicated good midterm outcomes of THA with both stems, the loading pattern differed. The anatomic short stem achieved its design purpose in terms of proximal fixation and load transfer and led to better preservation of the proximal femur. (C) 2016 Elsevier Inc. All rights reserved.