Trochantoplasty for Total Hip Arthroplasty in Patients With Coxa Vara Deformity

Background

In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed “trochantoplasty.” In this procedure, the medial half of the greater trochanter was removed during THA.

Metaphyseal‐Loading Anterolaterally‐Flared Femoral Stem in Cementless Total Hip Arthroplasty: Five‐ to Eleven‐Year Follow‐Up Evaluation

Using a nonlinear three‐dimensional finite element analysis simulating loading conditions, we designed a new type of proximal‐fitting, anterolaterally‐flared, arc‐deposit hydroxyapatite‐coated anatomical femoral stem (FMS‐anatomic stem; Japan Medical Materials, Osaka, Japan) for cementless total hip arthroplasty (THA) for Japanese patients with dysplastic hip osteoarthritis. The aim of the present study was to analyze the clinical and radiographic outcomes of the new stem. We reviewed 143 consecutive patients (164 hips; 13 men, 14 hips; 130 women, 150 hips; age at surgery, 56.6 ± 7.6 years, mean ± SD, range, 30–74) who underwent cementless THA using the FMS‐anatomic stem at a single institution, with a follow‐up period of 7.6 ± 1.6 years (range, 5.3–11.0). Harris Hip score improved from 46.1 ± 12.6 before surgery to 90.0 ± 8.9 points post‐THA. The 7.6‐year survival rate of the stem was 99.0% after revision for aseptic loosening. Radiographs at follow‐up confirmed the stability of the femoral stems within the femoral canal in all cases, with sufficient bone ingrowth. None of the patients had subsidence of the stem exceeding 2.0 mm within the femoral canal or changes in varus or valgus position of more than 2.0°. The FMS‐anatomic stem provided excellent results in patients with dysplastic hip osteoarthritis. Our analysis confirmed reduced radiolucency around the stem in Gruen zones, minimal subsidence, appropriate stress shielding, and promising medium‐term stability within the femoral canal in our patients.     

Cementless Total Hip Arthroplasty for Adult Patients With Sequelae From Childhood Hip Infection: A Medium-Term Follow-Up Study

BackgroundThe aim of this study is to evaluate midterm clinical and radiographic results of total hip arthroplasties (THAs) with cementless implants for adult patients with sequelae from childhood hip infection.MethodsBetween 2002 and 2016, 165 patients (165 hips) who had a hip infection during childhood were treated with THAs with cementless implants. The average duration of follow-up was 93.5 months (range 26-206). Clinical results were evaluated via the Harris Hip Score and radiographic results were analyzed with postoperative serial X-rays.ResultsThe average Harris Hip Score increased from 27 (range 8-53) before surgery to 91 (range 45-100) at the latest follow-up examination (P < .001). At the latest follow-up evaluation, 9 cementless acetabular components demonstrated partial, nonprogressive radiolucencies. No subsidence of more than 2 mm or evidence of a radiolucent line was observed around the femoral components. Intraoperative periprosthetic fractures occurred in 11 hips, including 3 acetabular fractures, 2 fractures of greater trochanter, 1 femoral shaft fracture, and 5 fractures of femoral calcar. Postoperative complications included 3 cases of periprosthetic infection, 1 episode of dislocation, 1 case of a femoral periprosthetic fracture, 5 cases of sciatic nerve injury, 1 case of femoral nerve injury, and 1 case of squeaking from a ceramic bearing surface.ConclusionCementless THA for adult patients with sequelae from childhood hip infection presents significant technical challenges and a relatively high complication rate. With meticulous surgical planning and anticipation for the key technical challenges frequently encountered, the medium-term clinical and radiographic results of THA in this setting were good with high implant survivorship and patient satisfaction.     

Modified Metaphyseal‐Loading Anterolaterally Flared Anatomic Femoral Stem: Five‐ to Nine‐Year Prospective Follow‐Up Evaluation and Results of Three‐Dimensional Finite Element Analysis

We have designed a proximal‐fitting, anterolaterally flared, arc‐deposit hydroxyapatite‐coated anatomical femoral stem (FMS‐anatomic stem; KYOCERA Medical, Osaka, Japan) for cementless total hip arthroplasty (THA) for Japanese patients with dysplastic hip osteoarthritis, using a nonlinear three‐dimensional finite element analysis simulating loading conditions. The Anatomic Fit stem was modified in the region of the arc‐sprayed surface, to allow more proximal appearance of spot welds. The aim of the present study was to analyze the clinical and radiographic outcomes of patients who underwent THA using this stem. We reviewed 73 consecutive patients (79 hips; 13 men 16 hips; 60 women 63 hips; age at surgery, 57.6 years, range, 35–78) who underwent cementless THA using the Anatomic Fit stem, at a follow‐up period of 7.1 years (range, 5.1–9.4). Harris Hip score improved from 40.7 ± 17.1 before surgery to 91.0 ± 5.2 points at follow‐up. The 7.1‐year stem survival rate was 100%. Radiographs at follow‐up confirmed the stability of the femoral stems within the femoral canal in all cases, with sufficient bone ingrowth. None of the patients had subsidence of the stem exceeding 2.0 mm within the femoral canal or changes in varus or valgus position of more than 2.0°. The Anatomic Fit stem provided excellent results. The nonlinear three‐dimensional finite element analysis demonstrated that the stem‐bone relative motion was 10 µm at the proximal end of the stem and proximal load transfer. Our analysis confirmed reduced radiolucency around the stem, minimal subsidence, appropriate stress shielding, and promising medium‐term stability within the femoral canal.     

Is a Total Hip Arthroplasty Stem in Varus a Risk Factor of Long-Term Mechanical Complication?

BackgroundThe impact of implanting cementless femoral stems in varus alignment on long-term mechanical complications remains poorly defined in the literature. The aim of our study was to compare survivorship and functional and radiographic outcomes of stems in varus alignment to those in neutral alignment with and average follow-up of 10 years.MethodsThis single-center, multisurgeon, retrospective case-control study compared a group of 105 total hip arthroplasty (THA) patients who had varus stem alignment (Varus Stem) to a matching group of 105 THA patients who had neutral stem alignment, operated on between January 2007 and December 2012. The primary outcome measure was implant survival. Secondary outcomes included functional (Harris Hip Score, Postel Merle d'Aubigné Score, thigh pain, dislocation and hip range of motion) and radiographic outcomes (radiolucency, osseointegration, heterotopic ossification, subsidence, and stress shielding).ResultsThere was no significant difference in implant survival between the 2 groups with 95.7% (±2.46) in the Varus Stem group versus 97.7% (±1.64) in the Neutral Stem group (P = .41) after an average follow-up of 10 years. There was no significant difference in clinical and radiographic outcomes between groups.ConclusionCementless femoral stems in varus alignment were not the cause of mechanical complications with an average follow-up of 10 years. The comparison between groups in terms of implant survival, functional, and radiographic outcomes does not show any significant differences. Positioning a femoral stem in varus alignment may be an alternative for surgeons wishing to restore preoperative offset and to ensure satisfactory hip stability.     

Difference in trochanteric thickness between well-aligned and malaligned polished collarless stem

BackgroundSurgical techniques and instruments are continuously evolving to improve placement of components in ideal position. We investigated if there is difference in greater trochanter thickness between the stems in satisfactory position and stems in malposition and to assess the ideal thickness of trochanter for femoral stem placement in neutral position as under reaming of trochanter can result in stem malposition.MethodsMeasurement of greater trochanteric thickness in 95 hip replacements (posterior approach) was performed by a junior doctor and two hip fellows using the trauma CAD/PACS software. The stem was considered neutral if the central axis of femur passes through the distal tip of stem in AP and in varus if the tip of stem was lateral to the femoral shaft axis.Results79 patients had stem in satisfactory position and 16 patients in varus malposition. Mean trochanteric thickness was 12.6 mm (+/−0.56 mm 95%CI, Median 12.5 mm, SD 2.5 mm) in neutral stems while mean thickness in the varus stem was 18.4 mm (+/−1.01 mm 95%CI, Median 17.8 mm, SD 2 mm). There was statistical significant difference between both groups with p< 0.0001 with intra-observer correlation at 99% between the senior personal while correlation was at 80% between the senior personnel and junior doctor. No statistically significant difference was noted in measurements between the senior personal.ConclusionsThe study confirms the significant difference in greater trochanteric thickness between the well aligned and misaligned femoral components. The study raises the possibility that trochanteric thickness can be used as an accessory surgical aid to check if sufficient broaching has been done laterally to allow the stem to be seated in neutral position with an ideal remnant thickness of 12.5 mm. A surgical instrument can be developed to measure the intraoperative thickness of the trochanter which can be a useful tool for young hip surgeons for better placement of components.     

Total Hip Arthroplasties for Hartofilakidis Type C1 and C2 High Hip Dislocations Demonstrate Similar Survivorship and Clinical Function at Minimum 10-year Follow-up With Cementless Implants

BackgroundThis study aimed to determine the differences in survivorship, clinical function, and complications among patients who have Hartofilakidis Type C1 or C2 developmental dysplasia of the hips and underwent total hip arthroplasty (THA) with cementless implants.MethodsThis retrospective study identified 84 Hartofilakidis Type C hips that underwent THA between 2002 and 2011 with a minimum 10-year follow-up (mean, 13 years, range, 10 to 19 years). Survivorship, latest Harris Hip Scores and satisfaction levels, radiographic outcomes (eg, implant stability, rate and length of subtrochanteric shortening transverse osteotomy, leg-length discrepancy, cup position, and orientation), as well as complications (eg, dislocation, periprosthetic fracture, periprosthetic joint infection) were compared to analyze the differences between Hartofilakidis C1 and C2 hips.ResultsBetween C1 and C2 hips, no difference existed in the 15-year cumulative Kaplan-Meier survivorship, with the endpoint defined as any reoperation (93.1 versus 90.8%), aseptic loosening combined with periprosthetic joint infection (93.1 versus 96.2%), or aseptic loosening (94.8 versus 96.2%), latest Harris Hip Score (87.1 versus 86.1%), vertical (6.1 versus 6.0 mm) and horizontal (11.5 versus 10.3 mm) distance to the anatomic center of rotation, postoperative leg length discrepancy (11.2 versus 15.5 mm), dislocation (5.2 versus 11.5%), stem aseptic loosening (6.9 versus 7.7%), periprosthetic fracture (3.4 versus 7.7%), and intraoperative femoral fracture (32.8 versus 23.1%). However, Type C2 hips demonstrated more severe preoperative leg length discrepancy (66.9 versus 42.5 mm) and required a higher percentage of subtrochanteric shortening transverse osteotomies (84.6 versus 36.2%) that were longer (33.7 versus 26.47 mm) than the Type C1 hips.ConclusionWith cementless cups positioned near the anatomic acetabular center and cementless stems combined with subtrochanteric shortening transverse osteotomies, THAs for the Hartofilakidis Type C1 and C2 hips demonstrated similar survivorship, clinical function, and complications.     

Minimum 10-Year Results of Cementless Ceramic-On-Ceramic Total Hip Arthroplasty Performed With Transverse Subtrochanteric Osteotomy in Crowe Type IV Hips

BackgroundTotal hip arthroplasty (THA) performed for developmental dysplasia of the hip is a technically difficult procedure with a high complication rate, especially in the presence of completely dislocated hips. This study aimed to evaluate at least 10 years of follow-up results of cementless, ceramic-on-ceramic (CoC) THA performed with transverse subtrochanteric osteotomy in Crowe type IV hips.MethodsWe retrospectively reviewed 50 patients’ 67 hips that underwent CoC, cementless THA with transverse subtrochanteric osteotomy between 2008 and 2011. Clinical and radiological data of the hips were examined. Clinical results were evaluated using the Harris Hip Score and the Western Ontario and McMaster Universities Osteoarthritis Index.ResultsThe mean Harris Hip Score improved from 22.9 ± 9.9 preoperatively to 94.1 ± 8.1 at the final follow-up (P < 0.001). The median Western Ontario and McMaster Universities Osteoarthritis Index score improved from 72 (interquartile range: 17) preoperatively to 2 (interquartile range: 17) postoperatively (P < 0.001). The preoperative mean leg length discrepancy was improved from 4.9 ± 1 cm to 1.5 ± 1 cm in unilateral cases at the last follow-up (P < 0.001). Revision surgery was required because of nonunion in two patients, prosthetic infection in one patient, and aseptic femoral loosening in the other patient. The overall ten-year survival rate was 94% for femoral stems and 98.5% for acetabular components as per Kaplan-Meier survival analysis.ConclusionTransverse subtrochanteric shortening osteotomy combined with using cementless acetabular and femoral components with a CoC bearing surface promises successful clinical results and high prosthesis survival in the treatment of Crowe IV hips at long-term follow-up.     

Influence of cementless femoral stems inserted in varus on functional outcome in primary total hip arthroplasty.

INTRODUCTION: Historically, cemented total hip arthroplasty (THA) femoral stems inserted in varus have yielded poor clinical results. Few studies to date have addressed the question of the effects of varus alignment on cementless stems. We conducted a retrospective review of 125 uncemented THA femoral stems implanted by a single surgeon from 1994 to 1999. METHODS: We conducted a retrospective radiographic review of 125 cementless primary THA femoral stems implanted by a single surgeon who used the Watson-Jones approach; we identified 16 stems implanted in varus, defined as >or= 5 degrees and thus analyzed the effect of varus alignment on functional outcome. We matched varus stems to a cohort of 16 nonvarus cementless stems and measured radiographic signs of loosening and subsidence, defined as > 2 mm. RESULTS: At 4 years postsurgery, there was no significant difference in range of motion or in Harris Hip Score (p > 0.5), and no cases showed evidence of radiographic loosening or subsidence (p = 0.226). CONCLUSIONS: Study results suggest there is no consequence of varus femoral alignment in the cementless stems. Although it is not recommended to implant stems in varus, there were no apparent radiographic or clinical consequences observed at up to 4 years postoperative in this small case series.     

Treatment of comminuted trochanteric fractures and non-union of trochanteric osteotomy in revision total hip arthroplasty

To explore the clinical efficacy of thetreatment of comminuted trochanteric fractures andtrochanteric osteotomy non-union in revision total hiparthroplasty with tension-band f‘Lxation.     

强直性脊柱炎生物型股骨柄重建的形态学研究

背景:髋关节受累严重影响强直性脊柱炎(AS)的功能状态及疾病预后.既往研究缺乏对于终末期髋关节受累患者进行全髋关节置换术(THA)的假体选择及其形态学研究.目的:调查AS患者THA重建股骨侧生物固定型假体类型的分布特点、假体与股骨髓腔的匹配程度及其与股骨近端形态学参数的关系.方法:回顾性分析2006年1月至2019年1...     

Long-Term Outcomes of Ultra-Short Metaphyseal-Fitting Anatomic Cementless Femoral Stem in Total Hip Arthroplasty With Ceramic-on-Ceramic Articulation for Young Patients

BackgroundThe aim of this study is to assess the long-term outcomes of this specific stem in patients younger than 50 years old, with regard to clinical and radiographic outcomes, survivorship, and complication rate.MethodsTwo hundred thirty-nine consecutive series of patients (324 hips) who were younger than 50 years old at the time of surgery were enrolled in the study. Osteonecrosis (50%) and dysplastic hip (34%) were most common diagnoses. Patients were informed to use crutches or walker for 4 weeks to protect the femoral component against rotational stress. The mean follow-up was 15.6 years (range 14-17).ResultsAt the latest follow-up, the mean Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score were 93 points, 13 points, and 7 points, respectively. Three patients (1.3%) had moderate thigh pain. All of the acetabular components and 321 (99%) femoral stems were solidly fixed at the time of the latest follow-up. Three stems (0.9%) were revised for aseptic loosening. Two hips (0.6%) had a dislocation and 2 hips (0.6%) had a periprosthetic fracture. Ceramic fracture or osteolysis was not found in any hip at the time of the final follow-up. Survival rate of the femoral component was 99.1% (95% confidence interval 94-100) and that of the acetabular component was 100% (95% confidence interval 94-100) at 15.6 years.ConclusionIn this series, THA using an ultra-short metaphyseal-fitting anatomic cementless femoral stem provided excellent long-term clinical and radiographic results in patients younger than 50 years old. Furthermore, our initial theoretical concerns about early aseptic loosening due to the absence of distal stem fixation were not justified.     

Mild Coronal Stem Malalignment Does Not Negatively Impact Survivorship or Clinical Results in Uncemented Primary Total Hip Arthroplasties With Dual-Tapered Implants

BackgroundProper component positioning in total hip arthroplasty (THA) is crucial for implant fixation and hip stability. The purpose of this study is to assess if neutral coronal stem alignment (0° ± 3°) improved long-term survivorship in uncemented femoral components.MethodsBetween 2005 and 2010, 1028 primary THAs were performed with 2 contemporary dual-tapered, proximally coated uncemented stem types. Alignment was measured immediately postoperatively and at most recent follow-up. In total, 978 femoral stems (95%) were within 0° ± 3° of the neutral anatomic coronal axis, and the 50 stems (5%) outside that range were considered outliers (3.1° of valgus to 4.8° of varus). Outcomes analyzed included implant survivorship, Harris Hip Scores, and incidence of dislocation. Mean follow-up was 5 years.ResultsSurvivorship free of aseptic femoral component loosening was 99.3% and 98.2% at 5 and 8 years in the neutral group vs 100% at 5 and 8 years in the outlier group (P = .98). Survivorship free of femoral component revision for any reason was 99.1% and 97.3% at 5 and 8 years vs 100% at 5 and 8 years, respectively (P = .80). Harris Hip Scores were similar (89 in both groups; P = .84) at most recent follow-up. The incidence of mild to moderate thigh pain was also similar in both groups (6.1% vs 6%, P = .85). The incidence of dislocation was 1.5% at 8 years, and similar between both groups (P = .77).ConclusionSlight malalignment of contemporary dual-tapered uncemented THA femoral components does not appear to negatively impact survivorship or clinical outcomes, which is in contrast to cemented femoral components.Level of evidence IIICase-control study.     

Revision Total Hip Arthroplasty With a Modular Cementless Femoral Stem

We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P < 0.001). The femoral stem was re-revised in eight patients (11%). The mean time to re-revision was 1.1 years (0.13–2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA.     

Acetabular Cup Revision Combined With Tensor Facia Lata Reconstruction for Management of Massive Abductor Avulsion After Failed Total Hip Arthroplasty

We report on 17 patients with massive abductor avulsions after total hip arthroplasty (THA) treated with medialization of the acetabular component and tensor fascia lata (TFL) reconstruction. All patients had severe limp, positive Trendelenburg sign, and avulsion of the abductor insertion confirmed on MRI. Mean age was 69 years (range, 50–83 years), and mean follow-up period was 36 months (range, 18–78 months). After surgery, 9 patients had no limp (47%), 8 patients had a mild limp, and abductor power improved from mean 2.5/5 to mean 3.8 (P < 0.0001). At latest follow-up, the Harris Hip Score was excellent in 6 hips (37%), good in 7 (43%) hips, and fair or poor in 3 (23%). Two patients with mild limp were not satisfied with their procedure.     

Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture

Purpose

Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip dysplasia.

Methods

The subjects included 66 hips in 64 patients, with the mean follow-up period of 7.3 years. THA was performed at a mean period of 17.1 years after intertrochanteric femoral osteotomy. Valgus osteotomy was performed in 42 hips, and varus osteotomy in 24. Clinical results were evaluated by using the Merle d’Aubigne-Postel score. Implant survival was determined with revision as the end point, and any related complications were investigated.

Results

The Merle d’Aubigne-Postel score improved from 9.4 to 16.1 at the final follow-up, without any implant loosening. However, periprosthetic femoral fractures were observed in four hips (6.0 %), one intra-operatively and three within three weeks after THA. Among these cases, three hips previously had varus osteotomy (12.5 %) and one hip had valgus osteotomy (2.3 %). Two hips were revised with full porous stems and circumferential wiring. The five and ten year cumulative survivorship rates were 97 % (range, 88.8–99.3 %) and 97 % (88.8–99.3 %), respectively.

Conclusions

Although the use of a press-fit cementless stem yielded acceptable results in most of the patients, perioperative femoral fracture was a major complication especially in the patients previously treated with intertrochanteric varus osteotomy. Careful planning and implant selection could be emphasized for these cases.

     

Long-Term Outcomes of Revision Total Hip Arthroplasty Using a Tapered and Fluted Modular Stem: A Mean Follow-Up of 16 Years

BackgroundTapered modular stems are increasingly used in revision total hip arthroplasty (THA) with deficient femoral bone stock. This study aimed to report the long-term outcomes of revision THA using a tapered and fluted modular stem.MethodsBetween December 1998 and February 2006, 113 revision THAs (110 patients) were performed with a tapered and fluted modular stem at a single institution. Hip radiographs were used to identify stem subsidence, stability, and femoral radiolucency. Final outcomes were assessed in 72 hips (70 patients), with a minimum follow-up of 10 years.ResultsThe mean follow-up duration was 16 years (range, 10-23). At the final evaluation, the Harris Hip Score improved from a mean of 41 points (range, 10-72) preoperatively to 83 points (range, 56-100) (P < .001). Six femoral re-revisions were performed for the following reasons: 1 aseptic loosening, 2 stem fractures, and 3 infections. One stem fracture occurred at the modular junction after 14 years, and the other at a more distal location after 15 years. Stem subsidence was >5 mm in 6 hips (9.1%), but secondary stability was achieved in all stems. Osseointegration was observed in 63 (95.5%) hips. Stem survivorship was 91.1% with an end point of any re-revision and 94.6% for aseptic re-revision.ConclusionA tapered and fluted modular stem demonstrated excellent implant survivorship with reliable bony fixation at a mean follow-up of 16 years. This type of stem can be a durable option for revision THA in patients who have femoral defects.     

Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site

BackgroundTotal hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site.MethodsFifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem.ResultsPostoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component.ConclusionSuccessful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.     

髋关节置换术后骨水泥股骨假体断裂原因分析及处理

目的 探讨骨水泥股骨假体断裂的原因和处理方法.方法 自2003年3月至2009年3月,共收治8例国产骨水泥股骨假体断裂患者,男6例,女2例.断裂距初次关节置换手术时间为36～98个月,平均72个月;体重60～88 kg,平均75 kg.均无明确外伤史.分析断裂前、后X线片,观察原假体安放位置、断裂部位、骨水泥固定情况及有无假体周围骨折;对术中假体表面骨水泥覆盖情况及断裂假体取出要点进行同顾性分析.5例行股骨假体翻修手术,采用生物碰股骨假体同定.3例转诊.翻修术后3个月、6个月、1年定期复查,行X线及Harris评估.结果 4例初次置换假体内翻,1例外翻;5例假体偏小.断裂均位于假体中点至中、远1/3交界处,远端崮定牢固.4例断裂前X线片可见近端假体周围细透光线,1例假体周围骨折.近端假体取出容易,远端假体取出困难.4例行股骨开窗,1例行转子延展截骨.翻修病例随访12～80个月,平均48个月.开窗或截骨部化平均愈合时间3.5个月.无假体松动、下沉及感染.末次随访时Harris评分85～97分,平均92分.结论 骨水泥股骨假体断裂可能与骨水泥假体近、远端固定质量不一致有关.对假体断裂者应及早行翻修术,术中股骨开窗安全有效.     

Cementless titanium tapered-wedge femoral stem: 10- to 15-year follow-up

This investigation is an ongoing clinical and radiographic analysis of a titanium tapered-wedge femoral component with a proximal plasma-spray porous coating. Integral femoral stems (Biomet, Warsaw, IN) were implanted in 200 hips in 186 patients. Nineteen patients died before 10-year follow-up, and 50 patients were lost to follow-up. The mean follow-up of the remaining 129 hips was 11.6 years. Harris Hip Scores improved from 58 to 93. Thigh pain was 2.3%. Radiographic analysis revealed adaptive distal remodeling in zones 2, 3, 5, 6, and 13, with no evidence of osteolysis below the level of the calcar and the greater trochanteric region. Only 2 femoral stems were revised: 1 with suspected fibrous fixation at 7 years postoperatively and another with a broken trunion at 10 years postoperatively. A tapered titanium femoral stem with circumferential plasma-spray porous coating provides excellent long-term fixation, durable clinical outcome, and protects against osteolysis below the level of the calcar and greater trochanter.