人工髋关节翻修病人假体周围骨密度的变化

[目的]使用双能X线骨密度仪（DEXA）测量9例人工髋关节翻修病人股骨近端假体周围骨密度,了解人工髋关节翻修病人假体周围骨丢失情况。[方法]因假体松动而接受初次人工全髋关节翻修手术病人9例,用双能X线骨密度仪（DEXA）对比测量双侧股骨近端骨密度,测量区域的划分采用Gruen七区法。术前临床评估以Harris髋关节评分（HHS）为标准。[结果]9例病人HHS评分61分,DEXA测量结果发现所有病人手术侧骨密度较非手术侧均出现明显下降,范围在8.9%～27.6%,平均15.4%,下降有统计学意义（P〈0.05）。[结论]人工髋关节置换术后早中期失败的病人,股骨近端假体周围骨丢失明显。     

股骨假体周围骨密度定量测定

目的 通过双能X线骨密度仪测定不同情况下股骨假体周围的骨密度变化情况,了解骨丢失与股骨假体松动的关系。方法 分为骨水泥固定的股骨假体组、非骨水泥固定的股骨假体组、股骨假体松动组共3个组,采用LUNAR DPXL-L型双能X线骨密度仅(Lunar Corp Wisconsin,USA)及Orthopaedies软件,分析时用Gruen’s 7区法。结果 骨水泥固定的股骨假体组骨丢失为15．1%～29．3%,非骨水泥固定的股骨假体组骨丢失为13．2％～27．9%,股骨假体松动组骨丢失为25．4％～43．4%,3组均是股骨近端骨丢失明显．骨丢失主要发生在术后8年以内。结论 骨水泥固定的股骨假体和非骨水泥固定的股骨假体周周骨密度降低一样,假体松动者假体周围骨丢失明显增加。股骨近端2个以上区域骨丢失大于35％或术后8年以后突然出现明显的骨丢失,考虑有股骨假体松动存在的可能性。     

短柄股骨假体全髋关节置换术后股骨近端骨改建及有限元分析

目的通过观察股骨假体周围骨密度改变情况来分析短柄股骨假体全髋关节置换术后股骨近端骨改建情况。方法纳入自2011-06—2016-06完成的71例全髋关节置换术,35例(37髋)采用短柄股骨假体(短柄组),36例(37髋)采用常规股骨假体(常规组)。比较两组术后1年疼痛VAS评分、髋关节功能Harris评分、股骨假体周围骨密度。采用有限元法分析两种股骨假体置入后的应力遮挡情况。结果 71例均获得随访,随访时间13～15(13.2±0.8)个月。短柄组与常规组术后1年疼痛VAS评分、髋关节功能Harris评分差异无统计学意义(P0.05)。与术后1周比较,术后1年短柄组股骨假体周围Gruen 1区和5区骨密度无明显变化,Gruen 4区骨密度降低,而Gruen 2、3、6、7区骨密度增加;常规组术后1年股骨假体周围Gruen 1、2、3、5、6、7区骨密度降低,而Gruen 4区骨密度升高。术后1年短柄组股骨假体周围所有Gruen分区骨密度均高于常规组,差异有统计学意义(P0.05)。有限元分析结果显示常规组股骨近端内侧与外侧均出现应力遮挡,而短柄组仅在股骨近端外侧出现应力遮挡。结论短柄股骨假体具有良好的力学传导特性,全髋关节置换术中使用短柄股骨假体可促进股骨近端骨改建并减少应力遮挡。     

ABG柄和SECUR-FIT HA柄全髋关节置换术后假体周 围骨密度改变的对比研究

目的比较全髋关节置换术采用ABG柄和SECUR-FIT HA柄对假体周围骨密度的改变,并分析影响因素。方法对我院2010年1月至2013年1月的56例(68侧)的全髋关节置换患者,27例(34侧)患者采用ABG柄(史塞克,美国),29例(34侧)采用SECUR-FIT HA柄(史塞克,美国)进行手术。术后我们采用双能量X线吸收测量法对两种股骨假体柄周围的骨密度进行测量,并进行比较。假体骨质分区方法采用Gruen法。结果 ABG组和SECUR-FIT HA组在1区和7区骨密度改变均有显著性差异(P0.05);SECUR-FIT HA组在2、6区骨密度改变同术前相比较有显著性差异(P0.05)。结论解剖柄能够减少应力遮挡作用,因此,ABG柄比SECUR-FIT HA柄骨量丢失范围小。     

全髋关节置换术后影响股骨假体周围骨量的因素

全髋关节置换术（Total Hip Arthmplasty，THA）是目前治疗严重骨性关节炎、类风湿性关节炎、晚期股骨头无菌性坏死等行之有效的方法，但其术后股骨近端骨的吸收造成假体远期松动，需要再次行翻修手术，如何解决假体松动仍是关节外科一个难题。影响全身骨量的因素很多，如年龄、性别、体重、废用、饮食结构、种族、生活方式等有着或多或少的某种联系；本文重点在于探索假体类型、固定方式对周围骨量影响。目前主要采用双能X线骨密度仪（Dualenergy X-ray absorptiometry，DEXA）按照Gruen’S分区监测假体周围骨密度（Bone mineral density，BMD）变化，本文就影响假体周围骨量的因素作一阐述。     

髓腔解剖交锁股骨假体人工全髋关节置换术后骨改建及远期临床疗效

目的探讨采用髓腔解剖交锁(anatomic medullary locking,AML)股骨假体行人工全髋关节置换术(total hip arthroplasty,THA)后股骨骨改建情况及远期临床疗效。方法回顾分析1997年11月—2003年1月应用AML股骨假体行THA治疗的24例(26髋)患者临床资料。男12例,女12例;年龄32～69岁,平均53.7岁。股骨头缺血性坏死5例(5髋),髋臼发育不良继发骨关节炎6例(7髋),股骨颈骨折6例(6髋),原发性骨关节炎2例(2髋),翻修术3例(3髋),强直性脊柱炎1例(2髋),股骨头骨折1例(1髋)。术后即刻、6周、3个月、6个月、1年及之后每年定期随访,分别行影像学评估(术后即刻摄X线片评价股骨峡部压配情况,Engh标准评定股骨柄假体生物学固定情况,术后发生异位骨化情况采用Brooker法评定);骨改建评估[假体与骨界面的改建(记录骨反应的类型、Gruen分区、发生率及出现时间),假体周围骨改建(根据Engh和Bobyn法评定股骨近端应力遮挡性骨吸收,并测量骨密度变化率)];临床疗效评估[Harris评分评价疗效、疼痛视觉模拟评分(VAS)评定大腿痛]。结果术后患者均获随访,随访时间15年2个月～20年4个月,中位随访时间16年6个月。术后即刻24髋(92.3%)股骨峡部压配良好,24髋(92.3%)有骨长入。术后3～6个月发生异位骨化1度2例、2度2例、3度1例。增生性骨反应多见于Gruen 2、3、4、5、6、10、11、12区,主要发生于术后6～20个月,发生率3.8%～69.2%,其中点焊征发生率最高;吸收性骨反应均为骨溶解,多见于Gruen 1、7区,主要发生于术后8年后,发生率42.3%,未见透亮线(区)、髓腔扩大征发生。21髋(80.8%)发生1度应力遮挡性骨吸收,5髋(19.2%)发生2度应力遮挡性骨吸收;主要发生于术后10～24个月,在Gruen 1、7区。双能X线吸收比色法检查示,骨密度减少主要发生在Gruen 1、2、6、7区,骨密度增加主要发生在Gruen 3、4、5区。术后2年后骨密度丢失进展缓慢。术后5～8年骨密度稳定,而8～9年骨密度丢失进展快,10年后骨密度趋于稳定。Harris评分从术前(51.1±6.2)分提高至末次随访时的(88.3±5.1)分(t=–21.774,P=0.000);仅2例(7.7%)发生轻度大腿痛(VAS评分为2分)。随访期间均未发生股骨假体无菌性松动和假体翻修。结论应用AML股骨假体行THA术后具有良好的骨改建模式,远期临床效果良好。     

地舒单抗对绝经后骨质疏松性股骨颈骨折全髋关节置换术后股骨近端假体周围骨密度的影响

目的:研究地舒单抗对绝经后骨质疏松性股骨颈骨折患者全髋关节置换术后(total hip arthroplasty,THA)股骨近端假体周围骨密度的影响。方法:选取2020年10月至2021年10月绝经后女性骨质疏松性股骨颈骨折行THA术后54例,治疗组25例接受地舒单抗治疗,年龄(74.3±6.2)岁;对照组29例未接受地舒单抗治疗,年龄(75.2±4.8)岁。术后1周及3、6及12个月各个时间点,通过双能X线骨密度仪(DEXA型)测定股骨近端假体周围骨密度,并在不同时间点测量骨转换各项指标。结果:术后3、6及12个月对照组的抗酒石酸酸性磷酸酶(tartrate resistant acid phosphatase,TRACP-5b)高于治疗组(P<0.05);对照组术后12个月骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BALP)高于治疗组(P<0.05)。两组患者Gruen 1、7区的骨密度在术后3、6及12个月较术后1周(基线)均下降(P<0.05);对照组Gruen 7区术后各时间点比较,差异有统计学意义(P<0.05);治疗组各时间点比较,差异无统计学意义(P>0.05)。两组术后3个月Gruen 1、7区比较,差异无统计学意义(P>0.05);术后6个月Gruen 1、7区和术后12个月Gruen 1、7区,治疗组骨密度均明显高于对照组(P<0.05)。两组术后3个月Gruen 1、7区骨密度下降百分比比较,差异无统计学意义(P>0.05)。对照组术后6个月Gruen 1、7区,术后12个月Gruen 1、7区骨密度下降百分比明显高于治疗组(P<0.05)。提示在使用地舒单抗6个月后,即可降低骨密度丢失幅度,并且该效应可达至术后12个月。结论:绝经后骨质疏松性股骨颈骨折患者在THA术后,使用地舒单抗可减少股骨近端假体周围骨密度丢失,有效抑制骨吸收。     

非骨水泥近端固定股骨柄和远端固定股骨柄中期随访时骨丢失的X线片表现

目的比较非骨水泥近端固定(anatomique benoist giraud,ABG)股骨干骺端与远端固定(anatomic medullary locking,AML)股骨干假体周围骨丢失特点,评价中期X线片表现。方法对1992年1月～1996年12月接受髋关节置换的患者,其中ABG176髋分别为:股骨头坏死103髋,先天性髋臼发育不良57髋,其他原因16髋,共计125例;AML220髋分别为:股骨头坏死147髋,先天性髋臼发育不良65髋,其他原因8髋,共计173例。术后随访5～12年,平均8年的髋关节X线片正位,对比术后即刻和随访时X线片显示的骨质变化,按照Gruen分区记录发生骨丢失;测量骨丢失的范围占假体周围骨长度的比例。比较两种假体周围骨丢失的特点。结果术中造成股骨干裂纹骨折ABG2髋,AML5髋;干骺端裂纹骨折ABG3髋,AML1髋。术后外伤骨折ABG6髋,AML3髋,2髋ABG行翻修术,余行复位内固定术。ABG随访期间9髋翻修,其中无菌松动7髋,骨折2髋;AML随访期间无菌性松动3髋,未翻修;ABG和AML发生骨丢失的部位相似,近端1和7区最先和最多出现骨丢失,随时间加重并由近端向远端发展。AML在2、5、6、7区发生骨丢失者多于ABG;AML假体周围骨丢失的范围大于ABG。结论骨丢失的主要原因为应力遮挡,AML远端固定,在假体近侧发生应力遮挡性骨丢失;解剖形近端固定的ABG股骨柄减少了应力遮挡作用和骨丢失。值得注意的是AML在10年后骨丢失发展缓慢,提示假体周围骨丢失不会无限制发展,保证了假体的长期稳定性。在术后12年内ABG假体周围骨丢失少于AML。     

采用羟基磷灰石涂层股骨柄假体行全髋置换术的早期疗效

目的总结采用羟基磷灰石(HA)涂层股骨柄假体行全髋关节置换术的早期疗效。方法2000年2月～2003年10月,采用钛合金HA涂层股骨柄假体行无骨水泥全髋关节置换术65例(70髋)。术前诊断:股骨颈骨折30例,骨关节炎15例,股骨头缺血性坏死9例,人工股骨头术后松动8例,类风湿性髋关节炎2例,髋关节融合1例。分别于术后1周、3个月、6个月,以后每年一次行髋关节功能和X线片检查,其中44例接受双能X线骨密度仪(DEXA)的骨密度(BMD)检查。结果术后X线片提示股骨柄假体的初始固定均符合优良标准。随访2～5.5年,平均3年。髋关节功能从术前Harris平均评分32分(25～52分)恢复至最后随访时的平均96分(85～100分),至今无一髋表现股区痛或需行翻修手术。术后1年内的X线片测量显示:<1.5mm下沉者7髋,其余均无假体下沉。至今无一例显示股骨近端或髓内骨溶解,也无一例显示假体松动。DEXA检查显示BMD在术后下降,然后迅速恢复,3～6个月后可达到正常或接近正常水平,其中Ⅱ、Ⅵ区的BMD增加速度最快,有时甚至高于对照侧。按Engh标准评定,全部患者均获骨性固定。结论近段HA涂层能增强股骨柄假体的初始固定,促进早期骨长入和骨性生物学固定,阻止聚乙烯磨屑的髓内移行和骨溶解,故用于无骨水泥全髋置换术的早期疗效满意。     

钛缆钢板结合抗骨质疏松治疗Vancouver B1型股骨假体周围骨折

目的 探讨钛缆钢板结合抗骨质疏松治疗Vancouver B1型股骨假体周围骨折的临床疗效。方法 2007年3月至2013年6月,9例Vancouver B1型股骨假体周围骨折患者行切开复位钛缆钢板内固定并结合抗骨质疏松治疗,对患者术后骨折愈合情况、髋关节功能进行评价,股骨近端按Gruen方法分7个测量兴趣区,术后3 d对健侧及患侧股骨近端7个分区进行骨密度测定。结果 9例患者均获得随访,随访时间19个月(12~36个月)。所有骨折均愈合,无感染、内固定断裂、股骨假体松动或下沉。髋关节Harris评分75~92分,平均82分,优良率达77%。假体周围骨折术后3 d患侧股骨假体周围所有Gruen分区骨密度均较健侧骨密度低(P0.05)。结论 髋关节置换术后假体周围存在不同程度的骨质疏松,钛缆钢板结合抗骨质疏松治疗Vancouver B1型股骨假体周围骨折髋关节功能恢复好,临床疗效满意。     

Prevention of potential fracture between two implants using interlocking bipolar cut short GK nail and Enders nail

A technique to prevent a potential fracture occurring between the distal end of a cementless hip prosthesis and the proximal end of a dynamic compression screw (DCS) is described. The method involves bridging the two implants using a bipolar shortened femoral nail. The proximal connection is secured by telescoping the stem of the hip prosthesis into the shortened femoral nail, which is further improved by filling the gap between the stem and the femoral nail with an Enders nail. The distal connection is secured by placing the distal locking screw of the femoral nail through the distal femoral plate of the dynamic compression plate first before locking the nail to the distal femur. Further stabilisation and promotion of healing at the distal femur were achieved using cement and bone graft.     

全髋关节置换前后股骨应力变化的有限元分析

目的:研究Chamley Elite骨水泥型和Summit近端多孔非骨水泥型股骨假体置换后股骨总体应力以及假体周围骨质区应力分布的变化。方法:根据Charnley Elite骨水泥柄和Summit非骨水泥柄假体形态建立三维有限元模型，并加载关节合力以及相关肌肉的肌力负荷，分析假体植入前后股骨总体应力模式并对股骨近端假体周围区域骨质应力分布进行分区量化研究。结果:两种假体植入后没有改变股骨总体的应力模式，应力峰值区域均位于全长股骨的中下段，但股骨应力峰值有所下降。股骨近端假体周围骨质等效应力水平出现了显著下降，下降最严重的区域为近段内侧象限即股骨距区，应力遮挡率分别达90．8％和95．3％；向假体远端应力水平逐渐增大，直至假体远段和末段水平应力值逐渐恢复并接近生理水平。就该两种不同固定方式的假体比较而言，引起的应力遮挡区域分布基本一致，应力下降程度Summit近端多孔非骨水泥型假体要高于Charnley Elite骨水泥型假体。结论:两种假体植入后均在股骨近端形成显著的应力遮挡，假体周围骨质应力大小和分布的改变是引起术后骨量丢失和假体松动的原因之一，也是术后股骨骨折发生的类型以术后肢体疼痛发生的力学基础。两种固定方式的假体均需通过进一步改进以减少应力遮挡。     

Early Failure of a Nonmodular Titanium Femoral Stem After Primary Hip Arthroplasty

Fully porous-coated cementless implants have a low failure rate and excellent survivorship in primary and revision surgery. Failure secondary to implant fracture is extremely rare with modern implant designs. We report an early fracture of a fully porous-coated femoral stem after primary total hip arthroplasty. The implant failed because of a filling mismatch between the proximal and distal femur.     

Revision total hip arthroplasty with an uncemented primary stem in 79 patients

INTRODUCTION: Revision in THA continues to be a technical challenge because of difficulties in fixation of the femoral component in mostly deficient bone in the proximal femur. In cases with minor cortical defects, the use of primary stems in revision surgery has also been described by some authors. MATERIALS AND METHODS: Seventy-nine patients with minor femoral bone defects were reviewed retrospectively (mean follow-up 6.8 +/- 3.9 years), who underwent a femoral component revision surgery using the uncemented primary Bicontact stem (Aesculap, Tuttlingen, Germany). Furthermore, the radiographs (anteroposterior and lateral) before, after surgery and at latest follow-up were analysed concerning femoral defects, proximal bone loss, and to determine the quality of bony fixation. RESULTS: The average Harris hip score (HHS) was 42.2 +/- 20.8 preoperative and improved to 78.9 +/- 12.5 at latest follow-up (p < 0.001). Motion Score increased significantly from 2.7 +/- 1.9 to 3.5 +/- 1.4 (p < 0.05) and pain score decreased significantly from 5.7 +/- 2.9 to 3.6 +/- 2.4 (p = 0.005). During follow-up there were only four re-revisions within 2 years after revision. The results and clinical outcome of this study correspond to those published before, using primary cementless stems in cases of revision. CONCLUSION: Therefore, the primary uncemented Bicontact stem appears to be a good alternative to other revision systems in well-selected femoral revision cases with minor defects.     

An in vitro comparison of surface strain patterns in cementless femoral arthroplasty

A hypothesis associated with applications of contemporary cementless pressfit femoral stem designs is that stems which uniformly fit the proximal medullary canal of the femur will result in load transmission patterns which approximate those of a normal femur. The objective of this study was to examine biomechanical variables such as implant/bone fit and the associated load transmission patterns of the proximal femur before and after cementless femoral arthroplasty utilizing the technique of reflection photoelasticity. Harris-Galante (Zimmer), S-ROM (Joint Medical Products), and INFINITY prostheses were implanted in cadaveric femora and subjected to conditions simulating single-limb stance loading. The bone/implant constructs were later transversely sectioned and fit was analyzed. Insertion and subsequent loading of both prothesis types resulted in a large decrease in strain in the medial calcar of each intact control. Visual examination of the Harris-Galante prosthesis under polarized light revealed patchy, localized areas of high strain along the proximal region. In contrast, the modular prostheses displayed more uniform and diffuse strain profiles with minimal regions of localized strain. In all cases, the surface strain patterns produced by cementless femoral arthroplasty correlated with the pattern and degree of implant/bone fit.     

Revision total hip replacement using a cementless interlocking distal femoral stem with allograft-cemented composite and the application of intramedullary and onlay cortical strut allografts: two case reports

It is often difficult to perform repeated revision total hip replacement (re-THR) after prosthesis loosening stemming from infection, mechanical loosening, and osteolysis. Reasons for this include the size of the bone defect and poor quality of the remaining bone. We have previously performed revision surgery using a cementless interlocking distal femoral stem with segmental cortical allograft-cemented composite for reconstruction in the presence of circumferential bone loss of the proximal femur according to Gustilo classification type IV [1]. However, in the case where the distal femur had a stovepipe canal due to osteoporosis, osteolysis, and infection, it was difficult to achieve stable fixation to the distal femoral cortical bone using a cementless interlocking distal femoral stem. Therefore, a cortical strut allograft is inserted into the femoral bone canal on the medial side, followed by the insertion of an interlocking stem. A further cortical strut allograft is inserted on the lateral side of the distal femur. In addition, the distal onlay allograft should pass over the allograft–host bone junction. The two allografts are finally secured with interlocking screws. The bone allografting to augment femoral bone deficiency was performed using mainly cadaveric bone allografts obtained from our bone bank [2, 3]. In this report, we describe two cases of re-THR involving the use of intramedullary and onlay cortical strut allografts with a cementless interlocking distal femoral long stem to achieve favorable fixation stability. The two patients were asked if the data from the case could be submitted for publication, and both gave their consent     

Uncemented femoral revision arthroplasty using a modular tapered,fluted titanium stem

Background and purpose — Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series.

Patients and methods — We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5–16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined.

Results — Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB–III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95–100).

Interpretation — This is one of the largest medium- to long-term analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years.     

The effect of collar and distal stem fixation on micromotion of the femoral stem in uncemented total hip arthroplasty

Collar seating and tight distal stem fit were evaluated for their effects on micromotion of the implant in the proximal femur. Collared and collarless implants were inserted with a cementless technique in 42 preserved femoral specimens from adult cadavers and cyclically axially loaded in a 9 degree valgus position. Micromotion was registered with dial indicators. Micromotion was minimized distally and proximally by achieving tight distal fixation. Collar seating prevented distal migration and failure of fixation, but it did not have a detectable effect on mediolateral or anteroposterior proximal micromotion. Toggle appears to be controlled primarily by the distal portion of the stem. Axial load transfer appears to be primarily controlled by collar seating. The least micromotion was achieved with a tight fit distally.     

Anatomically designed prosthesis without cement for the treatment of osteoarthritis due to developmental dysplasia of the hip: 6- to 13-year follow-up study

Background Morphological differences of dysplastic hips exist not only on the acetabular side but also on the femoral side. Therefore, for reconstructing the hip joint of these patients, the shape of the proximal femur is problematic for getting adequate “fit and fill” by cementless stems. The purpose of this study was to investigate the clinical and radiological outcomes of anatomically designed prostheses for the treatment of osteoarthritis due to developmental dysplasia of the hip. Methods A total of 81 consecutive primary cementless total hip arthroplasties using an anatomic hip system were performed in 75 patients (10 men, 65 women). The mean age at the time of the surgery was 59.0 years (range 41–84 years). The average duration of follow-up was 101.4 months (range 72–157 months). Clinical performance was evaluated using the Harris hip score (HHS), and radiographic findings were assessed using the fixation and stability score according to Engh et al. Results The average preoperative HHS was 44.5 points, and the most recent average HHS was 87.5 points. Altogether, 66 hips (81%) were deemed excellent (≥90 points) or good (80–89 points). The mean fixation and stability score was 19.6 ± 5.2 points. In total, 75 (93%) of the femoral components had bone-ingrown fixation, and 6 (7%) indicated possible ingrowth. There was osteolysis around five femoral components and three acetabular components. No femoral component was revised; however, five cups were revised because of breakage of the polyethylene or massive osteolysis. Dislocation of the hip implant was seen in one hip, but there was no recurrent dislocation. There was no deep infection, deep vein thrombosis, or nerve palsy. Conclusions The anatomic stem showed acceptable clinical and radiological results in cases with mild or moderate subluxation of the hip at the intermediate-term follow-up.     

Cementless femoral reconstruction in patients with proximal femoral deformity

Distorted proximal femoral anatomy can pose a great technical challenge during total hip arthroplasty. Fifty-eight total hip arthroplasty were performed in 51 patients with proximal femoral deformity from 1998 to 2006. All hips except 2 were treated with cementless prosthesis. Twenty-three patients had a retained hardware that had to be removed. Nonprimary cementless components were used in 22 (25%) femurs. In 21 (23%) hips, osteotomy was required to properly fit the cementless stem in the femur. At the time of latest follow-up (4 years on average), functional scores showed significant improvement. Radiographically, all femoral components showed stable bone ingrowth except 2 hips (3.5%) with stable fibrous ingrowth and 1 hip (2%) with loosening. There were 2 (3.5%) revisions in 2 patients for periprosthetic fracture and femoral loosening. The mechanical failure rate was 9% (5 hips). Despite technical difficulties, cementless femoral reconstruction provides a reliable and durable result in patients with proximal femoral deformity.