Early complications after one hundred and forty-four consecutive hip revisions with impacted morselized allograft bone and cement

BACKGROUND: The use of impacted morselized allograft bone and cement in hip revision arthroplasty has been popular, but studies that specifically address intraoperative and postoperative complications have been scarce. METHODS: All complications that occurred during, and within the first year after, 144 consecutive hip revision arthroplasties (108 stems and 130 sockets) performed with impacted morselized allograft bone and cement were recorded. Clinical and radiographic follow-up evaluation was performed at three months and at one year after surgery for all patients except eight (seven who had died of causes unrelated to the hip surgery and one who had sustained a stroke). Of these eight patients, seven had a six-week and/or three-month follow-up evaluation. RESULTS: Thirty-nine femoral fractures occurred in thirty-seven hips; twenty-nine of the fractures occurred during surgery and ten, within five months after surgery. Of the intraoperative femoral fractures, twelve were proximal, nine were diaphyseal, and eight involved the greater trochanter. Of the postoperative femoral fractures, one was proximal and nine were diaphyseal. Other intraoperative complications were the creation of a femoral cortical window in seven hips and incidental perforation of the femoral cortex in fourteen. Multivariate analysis showed the risk factors for femoral fracture during or after revision to be concomitant disease, greater deficiency of the femoral bone stock, and an intraoperative femoral window or perforation. Other complications included dislocation of the femoral head in nine hips, deep infection in one hip, persistence of preoperative deep infection in one hip, and superficial wound infection requiring wound débridement in two hips. CONCLUSIONS: We found the complication rate to be high after hip revision arthroplasty performed with impacted morselized allograft bone and cement. The most serious complication was postoperative diaphyseal femoral fracture.     

髋关节成形术治疗血液透析患者髋部骨折的短期疗效

目的探讨髋关节成形术治疗血液透析患者髋部骨折的短期疗效.方法 回顾性总结采用全髋或者半髋置换术治疗血液透析后髋部骨折的患者18例,男11例,女7例;平均年龄74岁（47～90岁）.所有患者均为诊断为慢性肾衰竭、慢性肾脏病（CKD）Ⅴ期,术前平均接受血液透析治疗的时间为4.2年（6个月～8年）.其中股骨颈骨折患者13例,股骨转子间骨折5例.根据骨折类型及采用的手术方式,将患者分为3组：A组6例股骨颈骨折患者,采用全髋关节置换术;B组7例股骨颈骨折患者,采用人工股骨头置换术;C组5例股骨转子间骨折患者,采用股骨头置换术.结果 13例患者获得随访,平均随访时间4年（1～7.3年）,术后Harris评分平均（81.0±8.4）分,优3髋、良4髋,疼痛评分平均（42.0±1.8）分.术后出现的并发症有：4例术后血肿;1例皮肤浅部感染;泌尿系感染3例,肺部感染4例;4例患者在围手术期死亡.患者的Harris评分与年龄有关.结论 采用髋关节成形术治疗血液透析患者髋部骨折能尽早让患者下地活动,避免长期卧床或者坐轮椅带来的各种并发症,有效的提高了患者的生活质量.     

Arthroplasty of the hip in patients with aplastic anemia

BACKGROUND: Patients with aplastic anemia are now living longer and therefore are at increased risk for the development of osteonecrosis of the hip. However, studies on the results of arthroplasty for the treatment of osteoarthritis of the hip in patients with aplastic anemia are lacking. METHODS: Twenty-six primary hip prostheses (one bipolar prosthesis fixed with cement, two bipolar prostheses fixed without cement, three hybrid total hip prostheses, and twenty total hip prostheses fixed without cement) were implanted, between March 1990 and May 1992, in nineteen patients who had been diagnosed with aplastic anemia. A specific prospective protocol was followed for the perioperative transfusion of platelets and blood. Twenty-five hips were replaced because of osteonecrosis of the femoral head, and one was replaced because of a femoral neck fracture. The patients were followed prospectively, with preoperative and serial postoperative Harris hip ratings as well as radiographs, for a minimum of six years or until death. RESULTS: No patient had excessive perioperative bleeding or a postoperative infection. After a mean duration of follow-up of seventy-nine months (range, seventy-two to ninety-five months), two patients had died with the original implant in place. No patients were lost to follow-up. The mean Harris hip score was 55 points (range, 42 to 68 points) preoperatively and 87 points (range, 56 to 95 points) at the time of the latest follow-up. At the time of this writing, no hip had been revised. One patient with a bipolar prosthesis had radiographic evidence of femoral loosening and will probably require revision. A second patient had some medial protrusion of a bipolar prosthesis, with mild symptoms. All of the acetabular components that had been fixed without cement and all of the other femoral components appeared to be stable on radiographs after a minimum of seventy-two months of follow-up. CONCLUSIONS: Total hip arthroplasty can be performed safely in patients with aplastic anemia. In the present intermediate-term study, the durability of implant fixation was maintained and the clinical results demonstrated a sustained increase in function of the hip.     

非骨水泥型人工双极股骨头置换术后中期随访结果

目的 观察新一代的非骨水泥型双极人工股骨头置换术的中期疗效。方法 用长入式非骨水泥型双极人工股骨头置换术治疗股骨颈骨折46例和股骨头无菌性坏死3例,随访时间平均4年(1年～6年1个月)。临床随访根据改良式Harris评分方法来比较效果的好坏。结果 术后获随访的33例患者Harris评分平均为97分,优良率97％。94％的患者无需止痛治疗,70％的患者患骸功能良好。40％的患者术后患侧下肢有明显肿胀,并伴发热。无一例髋关节脱位和假体周围再骨折。结论 非骨水泥型双极股骨头置换术术后早中期效果良好,固定牢靠。双极股骨头置换术手术简便,组织损伤少,可能是术后髋痛发生率很低的主要原因。     

人工关节置换治疗高龄重度骨质疏松性股骨粗隆间骨折的中期疗效随访

目的：观察人工髋关节置换治疗高龄重度骨质疏松性股骨粗隆间骨折病人的中期临床疗效。方法对2008年1月至2011年5月收治的71例高龄重度骨质疏松性股骨粗隆间骨折患者采用人工髋关节置换术,并随访其疗效。结果本组71例（72髋）,其中2例（2髋）采用全髋关节置换,69例（70髋）采用人工双动股骨头置换;年龄80～89岁,平均85.5岁。无一例术中休克或死亡。术后均在2～3 d下床活动,无肺炎、褥疮等并发症发生。随访时间11～72个月,平均47.7个月,术后死亡15例：术后1年内有7例;术后第2年有4例;术后第3年有3例;术后第4年有1例,其余病例均骨折愈合良好,未发生假体下沉、松动现象,术后行走功能恢复正常（术后Harris评分平均84.5分）。结论人工关节置换治疗高龄重度骨质疏松性股骨粗隆间骨折,可早期下地功能锻炼,减少卧床时间及并发症的发生,有利于早期功能恢复,但应严格掌握手术指征,远期疗效则需要进一步观察。     

Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial

BACKGROUND: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. METHODS: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. RESULTS: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford hip score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. CONCLUSIONS: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.     

Acute hip arthroplasty for the treatment of intertrochanteric fractures in the elderly

Arthroplasty for intertrochanteric fractures in elderly patients may allow early weightbearing and avoid fixation failure. Clinical results are reviewed in a consecutive group of acute arthroplasties (5 hemiarthroplasties and 29 total hip arthroplasties) performed via the anterolateral approach for intertrochanteric fractures. Age averaged 80.2 years. Follow-up averaged 35 months for living patients. Twenty-six patients died during follow-up. Time to death averaged 3.5 years. Five hips, all total hip arthroplasties, required subsequent surgeries: four for dislocation and one revised for sepsis. Acute intertrochanteric fractures are associated with high early mortality. In this series, a 15% complication rate and high mortality rate at 12 years was associated with acute arthroplasty. Dislocation is higher than in primary total hip arthroplasty utilizing the same surgical approach. The results do not support routine use of arthroplasty in treatment of intertrochanteric hip fractures in the elderly.     

Unipolar versus bipolar hemiarthroplasty: functional outcome after femoral neck fracture at a minimum of thirty-six months of follow-up

OBJECTIVES: This investigation was undertaken to compare a series of elderly individuals who sustained a displaced femoral neck fracture treated with either a cemented bipolar prosthesis or a cemented modular unipolar prosthesis. DESIGN: A retrospective review of prospectively collected data. SETTING: Hospital-based tertiary care orthopaedic trauma practice. PATIENTS AND PARTICIPANTS: Two hundred eighty-one community dwelling elderly patients sixty-five years of age or older who sustained a displaced femoral neck fracture (Garden Types III-IV) and underwent primary prosthetic replacement. INTERVENTION: One hundred one patients received a cemented bipolar prosthesis and 180 received a cemented modular unipolar prosthesis. MAIN OUTCOME MEASUREMENTS: The study was designed to determine whether there were any significant differences in: (a) the rate of prosthetic dislocation, postoperative medical and wound complications, or need for revision surgery, and (b) the functional outcome, including the incidence of hip pain and recovery of preinjury levels of ambulatory status and activities of daily living, at a minimum of thirty-six months of follow-up. RESULTS: The two groups of patients did not differ in preinjury characteristics (age, sex, American Society of Anesthesiologist rating of operative risk, number of comorbidities, fracture type, activities of daily living, ambulatory status). There were no significant differences in the rates of postoperative medical or wound complications or dislocation. Ninety-two patients died during the period of study. Forty patients were lost to follow-up or refused to participate. Consequently, 149 patients were followed for a minimum of thirty-six months. Functional ability was compared between both groups with regard to recovery of ambulatory status and activities of daily living, as well as the incidence of hip pain at a minimum of thirty-six months of follow-up. No significant differences were found between the unipolar and bipolar groups. CONCLUSION: Based on the results of this study, there does not appear to be any advantage to the use of a bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly. Furthermore, the extra cost of bipolar endoprostheses does not seem to warrant its use.     

Hip arthroplasty in chronic dialysis patients

We retrospectively reviewed 15 patients (24 hips) on chronic renal dialysis who underwent hip arthroplasty between 1970 and 1990. The average age at surgery was 39 years; the average follow-up was 8 years (range, 1–19 years). All follow-up of less than 5 years relates to those patients who died. Of these 24 hips, 14 (58%) failed or were failing due to loosening; the average time to revision was 7 years (range, 1.5–14 years). A complicated course was experienced in 16 hips (66%), primarily related to medical difficulties. There was one perioperative death. The following orthopedic complications afflicted 5 hips (21%): one femur fracture during revision; one femur fracture at 2 months after revision; one dislocation during seizure; one displacement of acetabular cup requiring recementing; and late generalized septic death of one patient (with both hips involved). Within an average of 3 years (range, 15 months to 7 years) after their index surgery, 6 of the 15 patients (40%) died. The patients who lived were chronically ill, and all but three remained on long-term dialysis. The functional level of all those remaining on dialysis steadily declined, and none reached a quality of life comparable to an osteoarthritic patient. This study confirms a previously reported high mortality and morbidity rate in this population. Despite their difficulties, 22/24 primary hips were relieved of pain and increased in function; six patients returned to work. We see no better alternative for pain relief in total hip arthroplasty, particularly in view of contemporary surgical techniques and improved medical management.     

髋关节置换术治疗股骨转子间骨折内固定失败

 目的 回顾性分析采用髋关节置换术治疗股骨转子间骨折内固定失败的临床效果。方法2004年7月至2006年6月,采用髋关节置换术治疗32例股骨转子间骨折内固定失败患者,男24例,女8例;行关节置换时的年龄为57～81,平均71岁;从骨折到行关节置换的时间为5～70个月,平均40个月。骨折内固定方式包括：滑动髋螺钉15例,髓内钉10例,钢板5例,多枚螺钉2例。失败原因：拉力螺钉切出股骨头8例,骨折不愈合9例,股骨头缺血性坏死7例,创伤性关节炎8例。采用全髋关节置换术28例（全部为生物型髋臼）,双极人工股骨头置换术4例。骨水泥型股骨柄12例,非骨水泥型股骨柄20例。标准股骨假体25例,长柄股骨假体7例。结果术后28例患者获得随访,随访时间4～6年,平均5年。28例患者术前H arris评分平均37分（32～45分）,末次随访时平均88分（84～95分）;优6例,良14例,可7例,差1例。末次随访时X线片显示假体位置正常,髋臼平均外展角为44°（42°～48°）,髋臼假体无松动。根据Harris标准评价骨水泥型股骨假体固定,1例为A级,9例为C级。根据Engh等标准评价非骨水泥型股骨假体的固定,18例均评价为骨长入。3例髋关节术后6个月复查时发现异位骨化,BrookerⅡ级2例,Ⅲ级1例。结论髋关节置换术是老年患者股骨转子间骨折内固定治疗失败后的一种有效挽救选择。     

Cementless Bipolar Hemiarthroplasty Using a Hydroxyapatite-Coated Long Stem for Osteoporotic Unstable Intertrochanteric Fractures

Treating senile osteoporotic patients with unstable hip fractures remains a challenge. We evaluated the results of 87 cementless bipolar hemiarthroplasties using an extensively hydroxyapatite-coated long stem for unstable intertrochanteric fractures in senile patients. Sixty-one hips were followed for a minimum of 2 years (mean, 36 months) postoperatively. The mean Merle d'Aubigne and Postel hip score was 14.7 points (12-18). Two hips were reoperated because of infection. Of the remaining 59 hips, 48 were included in the radiographic analysis. Although cortical porosis around the stem was seen in 18 hips, there was no loosening or osteolysis. Cementless bipolar hemiarthroplasty using an extensively hydroxyapatite-coated long stem is a useful option for the treatment of unstable intertrochanteric fracture in senile patients with severe osteoporosis.     

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.     

Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement

BACKGROUND: The purpose of this study was to assess the results of the use of a jumbo femoral head to restore stability in hips that had sustained recurrent dislocations after total hip replacement. METHODS: Twelve hips in twelve patients who had had multiple hip operations and recurrent instability of the hip underwent a total hip replacement with use of a femoral head with an average diameter of 44 mm (range, 40 to 50 mm). The average age of the patients was fifty-nine years (range, twenty-nine to eighty-four years). The twelve patients had had an average of four previous operations (range, one to eight operations) and seven dislocations (range, two to twenty dislocations). A bipolar head was used in ten hips that had a femoral stem with a fixed (non-modular) head, and a modular head (unipolar) was used in two hips. (One hip was first treated with a bipolar head and then with a unipolar head.) RESULTS: One patient died of unrelated causes fourteen months postoperatively. The hip had remained stable until the time of death. After an average duration of follow-up of 6.5 years (range, 3.2 to 11.8 years), ten of the remaining eleven hips had had no additional episodes of instability. One hip dislocated within one week after the revision, necessitating revision surgery to reposition the acetabular component. This hip was found to be stable at the time of follow-up 7.6 years after the revision. There were four other reoperations: one was done because of a fracture of the polyethylene; one, because of entrapment of cement within the articulation; one, because of pain related to loosening of the femoral stem; and one, because of late hematogenous infection. The preoperative and postoperative University of California at Los Angeles hip scores for the series were, respectively, 7 and 9 points for pain, 5 and 7 points for walking, 4 and 6 points for function, and 3 and 5 points for activity. CONCLUSIONS: A jumbo-diameter femoral head provided stability and improved function without compromising range of motion in patients with recurrent dislocations following total hip arthroplasty.     

Bipolar hip arthroplasty in ankylosing spondylitis

Nineteen severely affected hips in 12 young patients with ankylosing spondylitis were treated with bipolar hip arthroplasty followed by a comprehensive postoperative rehabilitation programme. Additional operative procedures of adductor tenotomy, knee flexion release, supracondylar femoral osteotomy for genu valgum and tendo Achillis lengthening for equinus contracture were required in 13 limbs. After a mean follow-up of 45.8 months, results were good in all cases with respect to relief from pain, and there was significant improvement in posture and function. All the patients resumed employment. The average gain in sum total range of hip movements was 194 deg, and the mean preoperative Harris hip score of 27.8 improved to 82.6 after bipolar arthroplasty. Ectopic ossification did not develop in any case. Bipolar hip arthroplasty appears to be ideally suited for young patients with ankylosing spondylitis.     

Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients

A retrospective study was conducted to assess the complications, clinical and functional outcomes at 5 years of follow-up of a series of elderly osteoporotic patients with an unstable intertrochanteric fracture treated by bipolar or total hip replacement. Fifty-four patients with an A2 intertrochanteric osteoporotic fracture were identified between 1996 and 2000. The average age of the patients was 81 years (SD=5). The follow-up time was 5 years. Patients received a bipolar or total hip replacement. During follow-up, we analyzed postoperative complications, mortality rate, functional results using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. One patient died intraoperatively; two patients died on the third and eighth postoperative days and seven patients died within 1 year. Twenty-five patients were living at the 5-year follow-up. Harris hip score at 1 month was 64±8 (mean±SD); at 3 months, 75±5; at 1 year, 76±5; and at 5 years, 76±9. Weight-bearing was permitted immediately after surgery, as tolerated. Time to return to normal daily activities was 27±5 days. No loosening or infection of the implants were observed. In elderly osteoporotic patients with an unstable intertrochanteric fracture, bipolar or total hip replacement in association with reduction of the greater trochanter is a valid alternative to the standard treatment of internal fixation. This surgical technique permits a more rapid recovery with immediate weight-bearing, and a maintenance of a good level of function, with little risk of mechanical failure.     

Analysis of outcomes for surgically treated hip fractures in patients undergoing chronic hemodialysis

BACKGROUND: Hip fractures in patients with end-stage renal disease are associated with frequent complications. This study analyzed clinical outcomes for patients on chronic hemodialysis who sustained hip fractures and were treated with a variety of fracture repair methods. METHODS: Twenty-nine patients with thirty-two hip fractures were analyzed in three groups. Group 1 consisted of eleven hips in eleven patients with an intertrochanteric fracture that was treated with internal fixation; Group 2, thirteen hips in ten patients with a femoral neck fracture that was treated with screw fixation; and Group 3, eight hips in eight patients with a femoral neck fracture that was treated with hemiarthroplasty. The outcomes and early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were compared. RESULTS: In Group 1, eight complications occurred in six hips and nonunion developed in five hips. In Group 2, sixteen complications developed in eleven hips. Union was achieved in two of the thirteen hips, nine hips had nonunion, and two hips had osteonecrosis develop. In Group 3, only one hip had early complications, there were no late complications, and three patients died. The mean duration of follow-up was twenty-three months, and the overall mortality rate was 45%. There were no significant differences among the groups with respect to the cumulative survival proportions. Regression analysis of age, sex, and total hemodialysis duration in relation to mortality risk revealed that only age had a significant influence on mortality (p = 0.019). CONCLUSIONS: Surgical treatment of hip fractures in patients with end-stage renal disease who are on chronic hemodialysis is associated with frequent complications and a high mortality rate. Osteosynthesis is an acceptable option for treating intertrochanteric fractures and nondisplaced femoral neck fractures, but displaced femoral neck fractures should be treated with hemiarthroplasty.     

Cementless total hip arthroplasty in patients older than 80 years of age

We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.     

'Pathological' fracture of the femur--a complication of failed total hip arthroplasty

Ten patients with a major femur fracture complicating total hip arthroplasty were seen at the Princess Alice Orthopaedic Hospital between June 1986 and May 1988. Four cases were intra-operative fractures sustained at revision surgery and 6 were late postoperative fractures of the femur associated with minimal trauma. Eight patients have a pain-free and functional hip arthroplasty at a mean follow-up of 19.7 months (range 17-32 months). One patient developed deep sepsis and 1 persistent non-union: both are now well mobilised following excision arthroplasty. Predisposing factors are identified and the importance of timeous intervention to avoid this challenging complication is stressed.     

Minimum ten-year results of primary bipolar hip arthroplasty for degenerative arthritis of the hip

BACKGROUND: Bipolar hip arthroplasty has been advocated by some as an alternative to total hip arthroplasty for the treatment of degenerative arthritis of the hip. We sought to assess the results of this procedure at our institution after a minimum duration of follow-up of ten years. METHODS: We retrospectively reviewed a consecutive series of 152 patients (173 hips) who underwent primary bipolar hemiarthroplasty for the treatment of symptomatic degenerative arthritis of the hip with a cementless femoral component between 1983 and 1987. Of the original cohort of 152 patients, ninety-two patients (104 hips) were available for clinical and radiographic review at a mean of 12.2 years postoperatively. At the time of the latest follow-up, self-administered Harris hip questionnaires were used to assess pain, mobility, activity level, and overall satisfaction with the procedure. Biplanar hip radiographs were made to evaluate bipolar shell migration, osteolysis, and femoral stem fixation. RESULTS: At the time of the latest follow-up, nineteen patients (nineteen hips) had undergone revision to total hip arthroplasty because of mechanical failure, and three patients (three hips) were awaiting revision because of symptomatic radiographic mechanical failure. Twelve acetabular revisions were performed or scheduled for the treatment of pelvic osteolysis or protrusio acetabuli secondary to component migration. Acetabular reconstruction required bone-grafting, an oversized shell, and/or a pelvic reconstruction ring. The overall rate of mechanical failure was 21.2% (twenty-two of 104 hips), with 91% (twenty) of the twenty-two failures involving the acetabular component. Reaming of the acetabulum at the time of the index arthroplasty was associated with a 6.4-fold greater risk of revision. The rate of implant survival, with revision because of mechanical failure as the end point, was 94.2% for femoral components and 80.8% for acetabular components at a mean of 12.2 years. Of the remaining sixty-nine patients (eighty-one hips) in whom the original prosthesis was retained, seventeen patients (24.6%) rated the pain as moderate to severe. Nearly 30% of patients with an intact prosthesis required analgesics on a regular basis. Radiographs were available for fifty-eight hips (including all of the hips with moderate to severe pain) after a minimum duration of follow-up of ten years; twenty-eight of these fifty-eight hips had radiographic evidence of acetabular component migration. CONCLUSIONS: This bipolar cup, when used for hemiarthroplasty in patients with symptomatic arthritis of the hip, was associated with unacceptably high rates of pain, migration, osteolysis, and the need for revision to total hip arthroplasty, especially when the acetabulum had been reamed. To the extent that these findings can be generalized to similar implant designs with conventional polyethylene, we do not recommend bipolar hemiarthroplasty as the primary operative treatment for degenerative arthritis of the hip.     

非骨水泥型全髋关节假体治疗强直性脊柱炎

目的:评价非骨水泥型全髋假体治疗强直性脊柱炎中期疗效。方法:对29例(33髋)选用非骨水泥型全髋假体行全髋置换术的强直性脊柱炎患者进行随访,年龄34～57岁,平均42.4岁,术后随访2.2～5.6年(平均为4.3年)。对手术前后关节疼痛、活动度、畸形矫正、松动及患者整体功能的改善情况进行对比研究,临床随访根据Har-ris系统进行评分比较。结果:本组失访5例,术后除6侧髋关节轻度疼痛,2侧髋关节明显疼痛外,其余关节均无疼痛。关节活动度由术前平均46.5°改善为术后75.2°。髋关节屈曲畸形由术前平均32.6°改善为7.5°。术前Harris评分18～65分,平均44分;术后68～92分,平均86分。术后所有患者生活均可自理或部分自理。术中及术后并发症包括:股骨上端微型劈裂骨折5例,坐骨神经损伤1例,术后2个月脱位1例,股骨假体下沉4例,异位骨化4例。结论:使用非骨水泥型假体行全髋置换术是治疗强直性脊柱炎的一种可靠而有效的方法。