Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip MINIMUM 15-YEAR CLINICAL AND RADIOLOGICAL RESULTS
Cementless total hip replacement without femoral osteotomy in patients with severe developmental dysplasia of the hip MINIMUM 15-YEAR CLINICAL AND RADIOLOGICAL RESULTS
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DOI：
10.1302/0301-620x.96b11.33698
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发表时间：
2014-11-01
影响因子：
4.6
通讯作者：
Walter, W. K.
中科院分区：
文献类型：
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作者：
Imbuldeniya, A. M.;Walter, W. L.;Walter, W. K.
我们描述了25例严重发育性髋关节发育不良(DDH)患者接受无骨水泥初次全髋关节置换术(THR)的临床和放射学结果。手术时平均年龄47岁(23~89岁)。总共有21个髋关节有Crowe III型发育不良，9个有Crowe IV型。采用标准聚乙烯衬里的非骨水泥型髋臼假体被引入到尽可能接近真实髋臼的水平。使用模块化无骨水泥S-ROM型股骨假体，低位切除股骨颈。共有21例患者(25个股骨颈)可供回顾，平均随访18.7年(15.8~21.8)年。平均改良Harris髋关节评分从术前的46分提高到最终随访时的90分(p<；0.001)。共有15名患者(17个THR；57%)接受髋臼假体翻修术，平均14.6年(7~20.8年)，均为骨溶解。两名患者(两名THR)出现症状性松动。没有患者接受股骨翻修手术。在任何适应症下翻修任何一种假体的存活率为81%(95%可信区间为60.1~92.3)，21名患者处于危险之中。这项技术可以减少重度DDH患者对股骨截骨的需求，同时提供良好的长期功能结果。
We describe the clinical and radiological results of cementless primary total hip replacement (THR) in 25 patients (18 women and seven men; 30 THRs) with severe developmental dysplasia of the hip (DDH). Their mean age at surgery was 47 years (23 to 89). In all, 21 hips had Crowe type III dysplasia and nine had Crowe type IV. Cementless acetabular components with standard polyethylene liners were introduced as close to the level of the true acetabulum as possible. The modular cementless S-ROM femoral component was used with a low resection of the femoral neck.A total of 21 patients (25 THRs) were available for review at a mean follow-up of 18.7 years (15.8 to 21.8). The mean modified Harris hip score improved from 46 points pre-operatively to 90 at final follow up (p < 0.001).A total of 15 patients (17 THRs; 57%) underwent revision of the acetabular component at a mean of 14.6 years (7 to 20.8), all for osteolysis. Two patients (two THRs) had symptomatic loosening. No patient underwent femoral revision. Survival with revision of either component for any indication was 81% at 15 years (95% CI 60.1 to 92.3), with 21 patients at risk.This technique may reduce the need for femoral osteotomy in severe DDH, while providing a good long-term functional result.