OSTEONECROSIS OF THE FEMORAL-HEAD TREATED WITH TOTAL HIP-ARTHROPLASTY WITHOUT CEMENT
OSTEONECROSIS OF THE FEMORAL-HEAD TREATED WITH TOTAL HIP-ARTHROPLASTY WITHOUT CEMENT
复制标题
DOI：
10.2106/00004623-199402000-00006
复制
发表时间：
1994-02-01
影响因子：
5.3
通讯作者：
SUTHERS, K
中科院分区：
文献类型：
--
作者：
PISTON, RW;ENGH, CA;SUTHERS, K
术前诊断为晚期（Ficat和Arlet iii期或IV期）股骨头骨坏死的30例患者（35髋）连续行全髋关节置换术，使用多孔涂层植入物。对患者进行临床和影像学评估，并以前瞻性的方式记录数据。平均随访时间为7年半（5至10年）。手术时患者的平均年龄为32岁（范围为21至40岁）。33例（94%）髋部出现股骨干与宿主骨骨融合的迹象。在这些髋关节的多孔涂层半球形髋臼杯中，发现并维持了最佳的骨-植入物界面，表明骨向内生长。股骨侧翻修率为3%（1髋），髋臼侧翻修率为6%（2髋），总体翻修率为6%。所有患者术后均保持高水平的活动。6例髋部有中度或重度股骨近端吸收骨重塑和应力屏蔽（17%），6例髋部有溶骨反应。并发症频繁（6髋），包括1例深部感染；两个混乱;异位骨化的两个实例；还有一处股骨跟骨折，发生在术中。这30例患者的翻修率较低，临床结果改善，与其他报道的一系列年轻患者相比，这些患者的诊断和术后随访相似。然而，后一个系列涉及较早设计的植入物，使用较旧的骨水泥技术植入。当考虑用关节置换术治疗年轻患者股骨头晚期骨坏死时，使用不带骨水泥的全髋关节植入物使骨向内生长似乎是一种可行的替代方法。然而，需要更长的随访时间来确定我们观察到的溶骨反应的结果。因此，由于并发症的高发生率和与溶骨反应相关的关节成形术失败的潜在可能性，我们谨慎地推荐这种手术。
With use of porous-coated implants, total hip arthroplasty was performed in a consecutive series of thirty patients (thirty-five hips) who had a preoperative diagnosis of late-stage (Ficat and Arlet stage-III or IV) osteonecrosis of the femoral head. The patients were evaluated clinically and radiographically, and the data were recorded in a prospective manner. The average duration of follow-up was seven and one-half years (range, five to ten years). The average age of the patients at the time of the operation was thirty-two years (range, twenty-one to forty years).Signs of osseointegration of the femoral stem to the host bone were demonstrated in thirty-three hips (94 per cent). In the porous-coated hemispherical acetabular cups of these hips, an optimum bone-implant interface was identified and maintained, suggesting bone ingrowth. The rate of revision was 3 per cent (one hip) for the femoral side and 6 per cent (two hips) for the acetabular side, for an over-all rate of 6 per cent. All patients maintained a high level of activity postoperatively. There was moderate or severe remodeling of proximal femoral resorptive bone and stress-shielding in six hips (17 per cent) and osteolytic reactions in six hips. Complications were frequent (six hips) and included one deep infection; two dislocations; two instances of heterotopic ossification; and one fracture of the calcar femorale, which occurred intraoperatively.The thirty patients had a lower rate of revision and improved clinical outcomes compared with other reported series of young patients managed with total hip arthroplasty with cement who had the same diagnosis and similar postoperative follow-up. However, the latter series involved implants of an earlier design that had been inserted with older techniques of cementing. When arthroplasty is considered for the treatment of late-stage osteonecrosis of the femoral head in young patients, the use of total hip implants without cement that allow for bone ingrowth appears to be a viable alternative to arthroplasty with use of cement. However, longer follow-up is needed to determine the outcome of the osteolytic reactions that we observed. We therefore recommend this procedure with some caution because of the high rate of complications and the potential for failure of the arthroplasty related to the osteolytic reactions.