混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

非骨水泥全髋关节置换术治疗股骨头缺血性坏死的中期疗效评估

目的对使用非骨水泥型假体行全髋关节置换术(totalhiparthroplasty,THA)治疗的股骨头缺血性坏死患者进行术后中期的影像学及临床评估,回顾性研究非骨水泥型假体的疗效及其影响因素。方法对1998年1月至2001年3月,采用非骨水泥型假体行THA治疗的股骨头缺血性坏死患者71例(80髋)进行至少5年的随访。临床评估以Harris评分为标准。影像学评估根据术后随访时骨盆正位与髋关节正、侧位X线片,观察髋臼、股骨假体的位置及其周围骨质的改变,并测量臼杯内衬的磨损速度、磨损方向。假体的生存率采用Kaplan-Meier分析,分别以髋臼、股骨假体的无菌性松动和任何原因所致的翻修为终点。结果共54例(62髋)患者获得至少5年的随访,术前Harris评分平均为(44.0±8.4)分(21～50分),终末随访时平均为(92.4±5.7)分(78～100分)。截至末次随访时无一例翻修或表现为影像学无菌性松动。1髋出现骨盆局灶性骨溶解,12髋出现股骨局灶性骨溶解。聚乙烯内衬平均线性磨损率为(0.125±0.074)mm/年。Kaplan-Meier分析假体生存率为1.0(95%可信区间,0.98～1.00)。结论多孔涂层非骨水泥型假体可为晚期股骨头缺血性坏死患者提供良好的中期固定及临床效果。然而,因为聚乙烯髋臼的磨损不可避免及假体周围骨溶解等潜在因素的存在,长期效果仍须进一步随访。     

全髋关节表面置换术治疗髋关节发育不良继发骨关节炎的早期疗效观察

目的 探讨全髋关节表面置换术(total hip resurfacing arthroplasty,THRA)治疗成人髋关节发育不良(developmental dysplasia of the hip,DDH)继发骨关节炎的早期疗效.方法 2005年3月至2006年6月,采用THRA治疗25位(26髋)DDH患者,女18例,男7例;年龄30～59岁,平均48岁.根据Hartofilakidis分型,半脱位22髋,低位脱位4髋.临床随访主要采用Harris评分,影像学测量指标包括CE角、Sharp角/臼杯外展角、股骨颈干角/柄干角、髋关节旋转中心、偏心距比值、髋臼假体覆盖率,记录髋臼假体周围透亮线及骨溶解,检测手术前后股骨颈及股骨近端的骨密度.结果 所有患者平均随访3.5年(3～5年),截至随访终点无翻修或影像学松动病例,Harris评分由术前平均(46.1±6.57)分提高到术后平均(92.1±2.59)分,优良率100%.臼杯外展角平均为41.6°±5.5°,柄干角平均为146.4°±3.2°,髋关节旋转中心位置平均下移3.9 mm,内移12.7 mm,宿主骨对臼杯的平均覆盖率为94.4%±4.2%.1髋宿主骨与臼杯界面在Deice 2区出现透亮线,宿主骨与股骨假体柄界面无1例出现透亮线.Gruen 1～6区术后6个月骨密度比率降低,术后6～36个月骨密度比率均有不同程度的增加;术后6个月时股骨颈外上区、股骨颈内下区和Gruen 7区骨密度比率已恢复至术前水平,术后36个月时上述三区的骨密度比率均高于术前.结论 THRA治疗半脱位型及低位脱位型DDH继发骨关节炎患者具有良好的临床疗效,THRA术后股骨近端骨量可以得到有效保存和恢复.     

生物型假体全髋关节置换术治疗成人髋关节发育不良继发骨关节炎的疗效评价

[目的]评价生物型假体全髋关节置换术(total hip arthroplasty,THA)治疗成人髋关节发育不良(developmental dysplasia of hip,DDH)继发骨关节炎的疗效.[方法]对2002年2月～2009年8月在本院行THA治疗的76例(102髋)髋关节发育不良继发骨关节炎患者的临床及影响学资料进行回顾性分析,其中男34例,女42例;年龄35～64岁,平均52.5岁.用Harris髋关节评分系统评价手术的临床疗效.根据骨盆平片及患髋正、侧位X线片观察髋臼、股骨假体的位置及其周围骨质变化.[结果]所有患者均获2年以上随访,平均5.3年.术后4例仍有轻度疼痛,服用非甾体类止痛药后缓解.8例存在不同程度下肢不等长(0.5 ～1.2 cm),Trendelenburg征阴性,无跛行.末次随访时Harris评分平均值(89.5±3.8)分,优46例(60髋),良20例(30髋),可10例(12髋);优良率为88.2％.末次随访时髋臼假体位置无明显移位,头臼包容性良好.30例出现异位骨化,6例出现髋臼周围骨溶解.股骨柄假体的位置无明显改变,中心固定有98髋(94.1％),柄-髓腔匹配优良率100％.4髋出现股骨侧骨溶解,8髋假体柄与股骨界面出现透亮线.所有病例均出现股骨近端骨重塑,其中Ⅰ度92髋,Ⅱ度10髋.无感染、假体松动、假体周围骨折等并发症发生.[结论]生物型假体全髋关节置换术治疗成人髋关节发育不良继发骨关节炎的疗效满意.     

混合型全髋关节置换术治疗股骨头缺血性坏死中期评估

目的回顾性研究混合型全髋关节置换术（total hip arthroplasty，THA）治疗股骨头缺血性坏死的疗效及其影响因素。方法1998年1月至2001年6月，对采用同一类型混合假体行THA的股骨头缺血性坏死患者57例（61髋）进行至少6．5年的影像及临床随访。观察髋臼、股骨假体的位置及其周围的骨质改变，并测量臼杯内衬的磨损速度与磨损方向。假体的生存率采用Kaplan—Meier分析，分别以髋臼、股骨假体的无菌性松动和任何原因所致的翻修为终点。结果患者Harris评分从术前平均（39．0±6．0）分（25～56分），提高到末次随访时平均（90．4±4．6）分（80-100分）。截至末次随访时，1髋（2％）出现骨盆局灶性骨溶解，拟行植骨治疗；7髋（11％）出现股骨局灶性骨溶解。聚乙烯内衬平均线性磨损率为（0．14±0．05）mm／年（0．02-0．45mm／年）。Kaplan-Meier生存分析表明，以任何原因导致的翻修或再手术为终点，髋臼与股骨假体的生存率分别为98％（95％置信区间，0．96-1．00）和100％（95％置信区间，0．95-1．00），以假体无菌性影像学松动为终点，髋臼与股骨假体的生存率均为100％（95％置信区间，0．95-1．00）。结论应用混合型假体行THA可以为晚期股骨头缺血性坏死患者提供完好的中期固定及临床效果。然而，由于聚乙烯磨损、骨溶解等潜在危险因素的存在，长期效果仍须进一步随访。     

初次混合式全髋关节置换术骨水泥柄的生存率分析

目的 探讨骨水泥柄全髋关节置换术后中期临床疗效.方法 接受骨水泥柄髋关节置换患者148例167髋,男95例106髋,女53例61髋;年龄28~87岁,平均62.8岁;体重45.2~87.4 kg,平均57.2 kg;身高146~184cm,平均161.5cm;平均体重指数21.4.临床疗效以Harris评分为标准,根据影像学资料评估股骨柄假体位置、骨水泥壳、假体周围骨重塑和骨溶解发生情况.以股骨假体无菌性松动和任何原因所致的假体翻修为终点,对假体生存率采用Kaplan-Meier分析.结果 106例114髋获得随访,随访时间6.5~9.5年,平均8.1年.术前Harris评分8~54分,平均42分;末次随访时76~100分,平均94分.无一例发生无菌性松动及假体翻修.6髋假体柄平均下沉1.83mm.16髋(14%)股骨侧出现<1mm的影像学透亮线,9髋(8%)Gruen Ⅰ区和Ⅶ区出现局灶性骨溶解所致斑点样影像学透亮区.106髋(93%)股骨侧有不同程度的皮质变薄或皮质松质骨化,均位于Ⅶ区.假体生存率为100%(95%可信区间.0.95-1.00).结论 采用第三代骨水泥技术固定股骨柄,可取得较好中期临床效果,但仍存在骨溶解、股骨近端皮质骨吸收重塑等潜在问题.     

保留股骨侧假体的髋关节翻修的临床疗效评析

目的探讨在髋关节翻修中保留股骨侧假体、单纯行髋臼侧翻修的短中期疗效。方法对2005年2月至2013年1月间采用保留股骨侧假体、单纯行髋臼侧假体翻修的31例31髋进行回顾性分析,其中男17例,女14例;年龄48~77岁,平均(64.32±8.76)岁。髋臼侧内衬磨损、无菌性松动、移位26例,髋关节脱位3例,髋臼骨折2例。股骨侧采用骨水泥固定的12例,生物固定的19例。进行翻修手术距离初次手术3个月~13年,平均(56.65±40.19)个月。18例翻修用髋臼与股骨侧假体保持同一厂家,13例因产品原因更换厂家。术中常规先行股骨侧假体稳定性的测试,评估股骨侧假体位置,对于股骨近端存在骨溶解的病例,溶解骨清理后进行打压植骨,单纯行髋臼侧翻修,采用Harris评分和X线片对其临床效果进行评估。结果术后随访12~103个月,平均(53.94±22.89)个月,Harris评分由翻修前平均(40.29±7.88)分增加至术后平均(86.42±5.2)分。所有患者无感染及关节脱位,未见假体移位,没有再翻修病例。结论全髋翻修中,根据患者年龄情况、股骨侧假体的固定情况、骨溶解的情况、初次置换假体选择情况、初次置换与翻修手术间隔时间情况,对部分患者采用保留股骨侧假体、单纯行髋臼侧翻修,可减少手术创伤,短中期随访效果满意。     

Crowe Ⅳ型髋关节发育不良人工全髋关节置换术后翻修原因及假体选择的研究

目的探讨CroweⅣ型髋关节发育不良(developmental dysplasia of the hip,DDH)患者人工全髋关节置换术(total hip arthroplasty,THA)翻修原因及翻修假体的选择。方法回顾分析2008年1月—2018年5月行翻修术的14例(15髋)CroweⅣ型DDH患者临床资料。男1例(1髋),女13例(14髋);翻修术时年龄27～63岁,平均45.0岁。左髋7例,右髋6例;双髋1例。初次置换假体摩擦界面类型:金属-聚乙烯界面(metal-on-polyethylene,MOP)9髋,陶瓷-陶瓷界面(ceramic-on-ceramic,COC)4髋,陶瓷-聚乙烯界面(ceramicon-polyethylene,COP)和陶瓷-金属界面各1髋。初次置换至翻修术时间为3～204个月,平均65.0个月。翻修原因:假体无菌性松动7髋,反复脱位3髋,感染2髋,骨溶解、截骨处不愈合、股骨柄前倾角偏小各1髋。术前髋关节Harris评分为(54.1±17.8)分,髋关节屈曲达(92.7±20.2)°。术前X线片检查显示髋臼侧骨缺损11髋,股骨侧骨溶解4髋。翻修术中假体摩擦界面5髋选择COP,其余患者均采用COC。11髋行髋臼及股骨侧翻修,4髋仅行股骨侧翻修。结果手术时间1.5～6.0 h,平均3.7 h;术中出血量为200～2 000 mL,平均940.0 mL。术后患者均获随访,随访时间16～142个月,平均73.9个月。X线片复查显示,初次置换术后及翻修术后臼杯外展角及前倾角比较,差异均无统计学意义(P0.05)。翻修术后旋转中心高度及股骨偏心距均高于初次置换术后,其中股骨偏心距差异有统计学意义(P0.05)。末次随访时,Harris评分为(85.0±7.3)分,髋关节屈曲达(115.0±17.0)°,均较术前明显提高(t=8.909,P=0.000;t=4.911,P=0.000)。翻修术后3例再次进行翻修。末次随访时15髋假体均稳定,未观察到透亮线;股骨柄均为中立位,未发生松动或下沉。结论 CroweⅣ型DDH患者THA术后翻修主要原因为假体无菌性松动。由于患者均相对年轻且关节活动度大,为了延长假体使用寿命,初次置换时不应使用MOP界面,COC界面更优。翻修术中使用金属垫块、加强环和Cup-cage均可达到良好的髋臼重建效果。S-ROM假体应作为初次置换及翻修的首选假体。     

比较人工全髋关节置换在治疗股骨头缺血性坏死和类风湿性关节炎中的作用

目的评估人工全髋关节置换（THA）在治疗股骨头缺血性坏死（AVN）和类风湿性关节炎（RA）中的作用。方法采用非骨水泥型THA治疗的42例（50髋）AVN和40例（50髋）RA患者,分别进行临床和影像学比较。临床随访包括Harris评分、术后翻修率和并发症分析;影像学评估包括骨溶解、聚乙烯臼杯磨损率分析。结果患者均获随访,时间5～10年。临床随访结果：AVN组和RA组Harris评分由术前（49.59±9.03）分和（48.76±7.61）分,术后分别提高到（90.76±5.64）分和（87.18±6.83）分,较术前均明显提高,但两组间Harris分值提高差异无统计学意义（P〉0.05）;AVN组和RA组术后翻修率分别为6%（3髋）和8%（4髋）,并发症分别为6%（3髋）和10%（5髋）,两组间差异无显著性（P〉0.05）。影像学结果：聚乙烯磨损率AVN组明显高于RA组,分别为（0.15±0.11）mm/年和（0.10±0.09）mm/年,两组比较差异有统计学意义（P〈0.05）;髋臼侧骨溶解发生率AVN组明显高于RA组,分别为18%（9髋）和4%（2髋）,两组比较差异有统计学意义（P〈0.05）;而股骨侧假体骨溶解发生率分别为20%和12%,两组比较差异无统计学意义（P〉0.05）。结论非骨水泥型THA在AVN和RA随访中均取得了良好的疗效,但AVN组髋臼侧聚乙烯内衬磨损和髋臼骨溶解高于RA组。     

全髋关节表面置换术治疗成人髋关节发育不良25例中期随访

目的探讨全髋关节表面置换术（total hip resurfacing arthroplasty,THRA）治疗成人髋关节发育不良（developmental dysplasia of the hip,DDH）继发骨关节炎的中期疗效。方法2005年3月至2006年6月,采用THRA治疗DDH患者25例,女18例,男7例;30～59岁,平均48岁;双髋1例,共26髋。根据Hartofilakidis分型,半脱位22髋,低位脱位4髋。采用Conserve-plus金属对金属全髋关节表面置换假体,髋臼假体为非骨水泥固定,股骨头假体采用低黏骨水泥固定。临床随访采用Harris评分,测量髋臼外展角、垂直距离、水平距离、股骨柄干角、髋臼假体覆盖率;记录髋臼和股骨假体周围透亮线及骨溶解;以各种原因所致翻修或影像学松动为随访终点。结果所有患者均随访3年以上,平均随访3.5年。截至随访终点无翻修或影像学松动。患者的Harris评分由术前平均46分提高至术后平均92.1分,26髋均为优。术后轻度跛行2例,所有患者均无迟发感染、术后股骨颈骨折、术后残余股骨头坏死、术后假体松动、脱位、术后异位骨化。髋关节活动度：屈曲由97.5°增加至127.5°,外展由19.3°增加至40°,外旋由23.2°增加至42.5°,内旋由4.2°增加至28.5°。X线片显示：关节假体位置正常,髋臼假体平均外展角为41.6°,髋关节旋转中心位置平均下移6.2 mm、内移15 mm,股骨柄干角平均146.4°。宿主骨对臼杯的平均覆盖率为94.4%,1例宿主骨与臼杯界面在2区出现透亮线,宿主骨与股骨假体柄界面无一例出现透亮线。结论THRA治疗成人半脱位型及低位脱位型DDH继发骨关节炎具有良好的中期疗效,熟练的手术技术和正确的适应证选择是降低中远期并发症的关键。     

Modular cementless total hip arthroplasty for multiple epiphyseal dysplasia

We analyzed a consecutive series of 23 total hip arthroplasties that had been performed using modular cementless prostheses in 13 patients with a confirmed diagnosis of multiple epiphyseal dysplasia and end-stage osteoarthritis of the hip. The average Harris hip score improved from 40.6 to 93.8 points. Postoperatively, all hips demonstrated favorable alterations in the biomechanical parameters including hip center of rotation, femoral offset, femoral neck length, and limb length. At a mean follow-up of 4.8 years, no hip required revision because of aseptic loosening of the acetabular or femoral component. One patient (1 hip, 4.3%) underwent reoperation for polyethylene wear and osteolysis 8 years after index arthroplasty. This study shows encouraging clinical and radiographic outcomes of modular cementless total hip arthroplasties for this technically difficult condition.     

The Harris-Galante cementless THA: a 19- to 25-year follow-up study

The goal of this study was to evaluate the long-term survivorship of primary cementless total hip arthroplasty (THA) using Harris-Galante porous I acetabular and Harris-Galante porous femoral components. From July 1985 to December 1991, we performed primary cementless THA on 76 hips (70 patients). Twenty-nine patients (31 hips) died due to causes unrelated to the THA, and 6 patients (7 hips) were lost to follow-up. Of 76 hips (70 patients) studied, 38 hips (35 patients) were available for follow-up at a mean 22.5 years (range, 19-25 years) postoperatively. Mean patient age at index procedure was 51.2 years (range, 42-65 years). Average Harris Hip Score was 40.5 points preoperatively and 85.8 points at final follow-up. No patient had an early or late postoperative deep infection. Radiographically, the acetabular component fixation was stable in all 38 hips. The femoral component was bone-ingrown in 26 hips, stable-fibrous in 10, and unstable in 2. One unstable hip required revision of the femoral component. Dissociation of the polyethylene liner occurred in 3 hips without fractures of the metal locking tines and required revision of the polyethylene liner and the articular head. A total of 4 hips had documented revision, and 1 femoral component failed radiographically. The survival rate with the endpoint defined as revision surgery and radiographic loosening was 86.8% at 22.5 years of follow-up. Mean polyethylene wear was 0.085 mm/year (range, 0.031-0.15 mm). This study found that the Harris-Galante porous I acetabular and Harris-Galante porous femoral components produce excellent long-term results.     

病灶清除植骨保留髋臼假体的翻修术治疗假体周围局灶性骨溶解

目的 探讨病灶清除植骨保留髋臼假体的翻修术治疗全髋关节置换(total hip arthroplasty,THA)术后稳定固定的髋臼假体周围局灶性骨溶解的疗效.方法 2006年3月至2009年3月,THA术后髋臼假体稳定固定的假体周围局灶性骨溶解患者23例(23髋),男13例,女10例;年龄39～54岁,平均46.6岁.23例均为非骨水泥髋臼.初次THA至诊断髋臼假体周围骨溶解的时间为4.6～7.4年,平均5.5年.术前HarTis髋关节评分74分.手术经腹股沟入路,行髂骨内板开窗,清除髋臼骨溶解病灶、同种异体颗粒骨植骨;经后外侧人路更换聚乙烯内衬、股骨头假体,保留髋臼假体.翻修术后1、3、6、12个月及之后每年随访1次,以髋关节Harris评分评价临床疗效,摄X线片、CT扫描观察植骨区愈合、新发骨溶解病灶及假体移位情况.结果 16例获得随访,随访时间8～38个月,平均28个月.末次随访时Harris髋关节评分86～100分,平均93.8分.16例植骨区成骨均良好,12例植骨区完全被周围骨爬行替代,髋臼假体固定好,无髋臼假体松动及移位,无新发髋臼假体周围骨溶解,无异位骨化、脱位、深静脉血栓形成及感染等并发症.结论 清除病灶植骨、保留髋臼假体、更换聚乙烯内衬和股骨头假体的翻修术可有效减少聚乙烯磨损颗粒产生,避免骨溶解病灶进展导致的假体松动,近期随访结果良好.     

Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup

BACKGROUND: Operative strategies to overcome the anatomical anomalies in patients with osteoarthritis secondary to developmental dysplasia of the hip remain controversial. The objective of this study was to determine the outcomes of total hip replacement with a grit-blasted cementless threaded cup and a cementless straight stem in patients with developmental dysplasia. METHODS: Ninety-three patients with developmental hip dysplasia who had been treated with a total of 121 cementless total hip arthroplasties were clinically assessed at a mean of 9.3 years. The acetabular reconstruction was done with a cementless threaded cup, which was medialized to ensure that at least one thread was anchored in the bone in order to achieve good primary stability. All radiographs were analyzed retrospectively. RESULTS: Kaplan-Meier survivorship analysis, with radiographic evidence of aseptic loosening as the end point, predicted a survival rate of 97.5% for the acetabular component and 100% for the femoral stem at 9.3 years. The average Harris hip score for the unrevised hips improved from 34.0 points preoperatively to 84.1 points at the latest follow-up evaluation. The average total volume of polyethylene wear at the time of final follow-up was 73.6 mm(3). CONCLUSIONS: These wear and loosening rates demonstrate that very good results were achieved in this relatively young patient population when the hip joint center had been properly restored, even when a small cup with a thin polyethylene liner had been used.     

Midterm Results of Hybrid Total Hip Arthroplasty for Treatment of Osteoarthritis Secondary to Developmental Dysplasia of the Hip-Chinese Experience

This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 ± 18.01, which improved to 91.78 ± 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia.     

Cementless total hip arthroplasty using a threaded cup and a rectangular tapered stem. Follow-up for ten to 17 years

We carried out a clinical and radiological review of 103 cementless primary hip arthroplasties with a tapered rectangular grit-blasted titanium press-fit femoral component and a threaded conical titanium acetabular component at a mean follow-up of 14.4 years (10.2 to 17.1). The mean Harris hip score at the last follow-up was 89.2 (32 to 100). No early loosening and no fracture of the implant were found. One patient needed revision surgery because of a late deep infection. In 11 hips (10.7%), the reason for revision was progressive wear of the polyethylene liner. Exchange of the acetabular component because of aseptic loosening without detectable liner wear was carried out in three hips (2.9%). After 15 years the survivorship with aseptic loosening as the definition for failure was 95.6% for the acetabular component and 100% for the femoral component.     

Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.

We performed a prospective study in 108 consecutive patients (116 hips) who were followed for a minimum of 10 years (10-12 years) after primary total hip arthroplasty using an uncemented porous-coated anatomic (PCA) hip prosthesis. The average age of the patients at operation was 48.4 years (range, 19-85 years), and the diagnosis was avascular necrosis of the femoral head in 46 hips, neglected femoral neck fracture in 27, osteoarthrosis secondary to childhood pyogenic arthritis in 24, childhood tuberculous arthritis in 5, and miscellaneous in 14. The average preoperative Harris Hip Score was 55 points, which improved to 87 points at 11 years. Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. The overall rate of revision was 15% (17 of 116 hips). The rate of revision of the femoral component was 11% (13 of 116 hips), and the rate of revision of the acetabular component was 15% (17 of 116 hips). The prevalence of thigh pain was 28% at 11 years. The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years' follow-up. At 11 years, there was femoral osteolysis in 69 hips (59%) and acetabular osteolysis in 65 hips (56%). At 6 years, 20 hips (17%) showed definite wear of the polyethylene liner. At 11 years, 81 hips (70%) showed definite wear of the polyethylene liner. Because the complication rate of the PCA hip prosthesis with respect to loosening, osteolysis, and excessive wear in the polyethylene liner is high, we abandoned the use of this implant.     

H/G非骨水泥人工全髋关节置换术后聚乙烯内杯磨损临床研究

目的 对H/G非骨水泥人工全髋关节置换术后聚乙烯内杯的磨损及髋臼周围骨溶解的情况进行总结.方法 我院1991至1995年共进行58例(65髋)H/G非骨水泥人工全髋关节置换,其中35例(40髋)获得10年以上随访.对这35例(40髋)患者获得随访的病例,采用计算机数字化方法测量髋臼聚乙烯内杯的二维线性磨损.结果 35例40髋均有不同程度的磨损,磨损范围2～8 mm,平均磨损为(0.32±0.31)mm/年.10髋聚乙烯磨损超过6 mm,髋臼假体周围的骨溶解严重,并伴有金属假体的移位,其中5髋聚乙烯内杯完伞磨透,金属股骨头与金属髋臼相接触;5髋聚乙烯内杯磨损严重伴明显骨溶解,内杯松动.2髋聚乙烯内杯脱位.共实施翻修手术12例,包括更换聚乙烯内杯和金属股骨头2例、金属闩杯翻修2例、全髋翻修8例.28髋在髋臼侧发现骨溶解,其中14髋股骨侧亦有骨溶解发生.结论 本组病例所观测到的H/G髋臼聚乙烯内杯的磨损程度超过文献所报道,而且由于磨损产生的大量磨屑,导致假体周围出现明显骨溶解,直接影响到假体的稳定.关节置换术后应定期随访,避免出现严重骨溶解后增加翻修手术的困难.     

Cementless total hip arthroplasty in Chinese patients with osteonecrosis of the femoral head

This study was designed to evaluate the midterm (> or = 5 years) clinical and radiographic outcomes of the cementless total hip arthroplasty in 64 Chinese patients (72 hips), which revealed that the mean Harris hip score increased from an average of 44.0 points before operation to 92.4 points at the last follow-up. Excellent results were achieved in 60 hips (83%). No loosening of the components was observed radiographically. No revision of the femoral components was required. Only one focal area of pelvic osteolysis in 1 hip (1%), which requires a revision, and some small focal areas of femoral osteolysis in 12 hips (17%) were observed. The mean linear wear rate was 0.125 mm/y. The survival rate of the acetabular and femoral components for radiographic loosening was 100% (95% confidence interval, 0.93-1.0) and for revision was 98.61% (95% confidence interval, 0.95-1.0). This study indicated that the cementless total hip arthroplasty in patients with osteonecrosis of the femoral head has a satisfactory midterm clinical and radiographic outcomes, but the long-term effect should be further studied.     

Total hip arthroplasty with a cementless acetabular component and a cemented femoral component in the treatment of Chinese patients with femoral head necrosis

The purpose of this study was to evaluate midterm clinical and radiographic outcomes associated with hybrid total hip arthroplasty in a consecutive series of 86 Chinese patients (93 hips) with osteonecrosis of the femoral head, which revealed that the mean Harris hip score increased from 39 +/- 6.0 points before operation to 90.4 +/- 4.6 points at the latest follow-up. There was pelvic osteolysis in one hip (1%), which required revision, and some small focal areas of femoral osteolysis in 12 hips (13%) were observed. The mean linear wear rate was 0.143 +/- 0.05 mm/y (0.02-0.45 mm/y). No loosening of the components was observed radiographically. The survival rate of the acetabular and femoral components for revision was 98% (95% confidence interval, 0.96-1.0) and 100% (95% confidence interval, 0.95-1.0). Hybrid total hip arthroplasty in patients with osteonecrosis of the femoral head had a satisfactory clinical and radiographic outcome at a minimum 5 years of follow-up. Because polyethylene wear and osteolysis cannot be avoided, the long-term effect should be further studied.