Comparison of 5-year postoperative results between standard-length stems and short stems in one-stage bilateral total hip arthroplasty: a randomized controlled trial
Comparison of 5-year postoperative results between standard-length stems and short stems in one-stage bilateral total hip arthroplasty: a randomized controlled trial
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DOI：
10.1007/s00590-020-02828-7
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发表时间：
2021-05-01
影响因子：
1.7
通讯作者：
Jinno, Tetsuya
中科院分区：
文献类型：
--
作者：
Hirao, Masanobu;Miyatake, Kazumasa;Jinno, Tetsuya
目的短股骨柄最近在全髋关节置换术中流行。以前的研究旨在阐明短茎的有效性，并没有消除除茎长以外的其他因素的影响。本研究旨在评价短股骨柄与具有相同近端形态、表面涂层和材料的标准长度股骨柄相比的有效性。方法本研究是一项前瞻性随机研究，比较了29例患者的5年中期结局，这些患者接受了一期双侧全髋关节置换术，在双侧股骨中插入短而标准长度的股骨柄。比较了临床、放射学和双能X线吸收测量结果。结果两组患者的围手术期和影像学特征（股骨颈前倾角、外展指数、手术顺序、术侧、手术时间、股骨柄前倾角和股骨柄对线）无显著差异。术后5年发生并发症的关节数量、股骨柄周围不透射线线的外观或股骨柄区域的骨矿物质密度发生变化。然而，在短股骨柄一侧观察到股骨柄的微动更大。双侧髋关节功能均得到满意改善。结论根据5年中期结局，尽管短股骨柄的微动更大，但两种股骨柄均获得了满意的临床结局。两种股骨柄均实现骨长入固定。此外，股骨柄在应力遮挡方面没有显著差异;然而，需要进一步的长期研究（> 5年）来验证我们与应力遮挡相关的发现。
Purpose Short stems have recently become popular in total hip arthroplasty. Previous studies aimed at elucidating the efficacy of short stems did not eliminate the influence of other factors aside from stem length. This study aimed to evaluate the usefulness of short stems compared with that of standard-length stems that have the same proximal morphology, surface coating, and material. Methods This was a prospective randomized study comparing 5-year midterm outcomes in 29 patients who underwent one-stage bilateral total hip arthroplasty with short and standard-length stems inserted in each of the two femurs. Clinical, radiographical, and dual-energy X-ray absorptiometry outcomes were compared. Results No significant differences were found in perioperative and radiographic characteristics (femoral neck anteversion, flare index, operation sequence, operation side, operation time, stem anteversion, and stem alignment). The number of joints with complications, appearance of radiopaque lines around the stems, or bone mineral density changed in stem regions 5 years postoperatively. However, greater micromotion of the stem was seen on the side of the short stem. Satisfactory improvement in hip function was seen on both sides. Conclusion Based on the 5-year midterm outcomes, both stems obtained satisfactory clinical outcomes despite the greater micromotion with short stems. Both stems attained bone ingrowth fixation. Moreover, the stems were not significantly different in terms of stress shielding; however, further long-term studies (> 5 years) are required to validate our findings related to stress shielding.