Clinical and radiographic outcomes of primary total hip arthroplasty with the revelation hip system using density mapping
Clinical and radiographic outcomes of primary total hip arthroplasty with the revelation hip system using density mapping
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使用密度图显示髋关节系统进行初次全髋关节置换术的临床和影像学结果
DOI：
10.1007/s00590-022-03210-5
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发表时间：
2022
影响因子：
1.7
通讯作者：
Murakami Hideki
中科院分区：
文献类型：
--
作者：
Sakai Hiroaki;Watanabe Nobuyuki;Kuroyanagi Gen;Fukuoka Muneyoshi;Usami Takuya;Ueki Yoshino;Murakami Hideki
Revelation髋关节系统是一种非骨水泥型股骨柄，具有外侧扩口概念。通过将股骨柄与股骨近端外侧皮质的髓腔匹配实现稳定固定。使用Revelation髋关节系统进行全髋关节置换术的患者显示出良好的术后临床和影像学结局。然而，据我们所知，没有研究报告股骨柄匹配与术后临床或影像学结局之间的关系。在本研究中，我们调查了使用Revelation髋关节系统进行全髋关节置换术（THA）后股骨柄匹配与临床或影像学结局之间的关系。在本研究中，26例患者的28个髋关节接受了Revelation髋关节系统治疗骨关节炎、股骨头坏死、类风湿性关节炎和快速破坏性髋关节病，并随访> 5年。根据密度图分析结果将患者分为两组，即静息组（R组）11髋和对照组（C组）17髋。在R组中，股骨柄的外侧与股骨近端外侧皮质的髓腔匹配，而在C组中，股骨柄的外侧不匹配。影像学结果显示，两组在股骨柄对线、下沉和髋臼杯周围应力遮挡方面无显著差异。7区股骨柄周围应力遮挡的发生率不显著，但R组的发生率往往高于C组（p= 0.052）。临床结局显示，R组和C组在Harris髋关节评分、日本骨科协会（乔亚）评分和日本骨科协会髋关节疾病评估问卷（JHEQ）总分方面无显著差异。然而，在最终随访时，使用36项简明健康调查表（SF-36）身体疼痛和活力子量表和JHEQ疼痛子量表通过患者报告结局评估的疼痛投诉在R组中显著高于C组。这些结果表明，即使在使用Revelation髋关节系统进行THA后按照概念插入股骨柄，一些患者仍有疼痛主诉。试验注册911。
The Revelation Hip System is a cementless stem with a lateral flare concept. Stable fixation is achieved by fitting the stem to the medullary cavity of the proximal lateral femoral cortex. Patients who have undergone total hip arthroplasty using the Revelation Hip System show good postoperative clinical and radiographic outcomes. However, to the best of our knowledge, no study has reported the relationship between stem fitting and clinical or radiological outcomes after the surgery. In the present study, we investigated the relationship between stem fitting and clinical or radiological outcomes after total hip arthroplasty (THA) using the Revelation Hip System. In this study, 28 hips of 26 patients who were treated with the Revelation Hip System for osteoarthritis, osteonecrosis of the femoral head, rheumatoid arthritis, and rapidly destructive coxarthropathy and were followed up for > 5 y were enrolled. These patients were divided into two groups, including the rest fit group (11 hips, group R) and the control group (17 hips, group C), according to the results of the density mapping analysis. In group R, the lateral side of the stem fits on the medullary cavity of the proximal lateral femoral cortex, while in group C, the lateral side of the stem did not fit. Radiographic results showed no significant differences between the groups in terms of stem alignment, subsidence, and stress shielding around the cup. The incidence of stress shielding around the stem in zone 7 was not significant but tended to be higher in group R than in group C (p= 0.052). Clinical outcomes showed no significant differences between group R and group C in terms of the Harris hip score, the Japanese Orthopaedic Association (JOA) score, and the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) total score. However, pain complaints that were assessed by patient-reported outcomes using the 36-Item Short Form Health Survey (SF-36) bodily pain and vitality subscales and the JHEQ pain subscale were significantly higher in group R than in group C at the final follow-up. These results suggest that some patients had pain complaint even if the stems were inserted as per the concept after THA with the Revelation Hip System.Trial Registration911.