非骨水泥长柄假体在髋关节翻修术中的应用

目的回顾性分析非骨水泥全涂层长柄假体在全髋关节翻修术中应用的临床疗效。方法对2006年1月至2011年1月四川大学华西医院收治的采用全涂层长柄假体全髋关节翻修术的53例患者（53髋）进行随访、分析。其中男26例,女27例;年龄49—78岁,平均62岁。股骨假体采用强生（Depuy）公司全涂层长度为165mm的直柄AML假体10例、全涂层165mm的Solution假体19例和203mm带弧度分左右侧的Solution假体24例。比较髋关节术前术后的Harris评分,x线片评价假体柄有无松动下沉及应力遮挡情况。结果53例患者均获随访,随访时间1．8～6．8年,平均4．7年。术前平均Harris评分为37分,最后随访时增加至86分。所有患者均在术后3个月后完全负重,原有髋关节疼痛缓解。在最后随访时,有45例股骨柄假体获得骨长人固定。并发症：术后脱位1例,手法复位后未再发生脱位,术后感染1例,假体柄明显下沉1例,后两例患者行再次翻修术,末次随访假体柄稳定。随访X线片显示多数患者骨质改建,密度增加,未发现假体周围有连续亮带及假体柄下沉的患者。结论复杂的股骨侧翻修手术,应尽可能选择非骨水泥长柄假体。特别是股骨干骺端骨质条件差,中段有骨缺损,近端不能获得牢固固定的病例。术中结合同种异体颗粒骨打压植骨处理股骨中上段中重度骨缺损,中期临床疗效良好,远期效果有待随访。     

人工髋关节翻修术的临床分析（附32例报告）

目的探讨人工髋关节翻修术的翻修原因、临床特点及手术方法。方法对32例人工髋关节翻修术的临床资料进行回顾性分析。取髋关节后侧入路,取出松动的股骨侧及髋臼侧假体,根据缺损情况植骨,然后按技术要求换置假体。结果2例术中出现股骨骨折,行内固定术,愈合良好。1例髋臼行植骨、骨水泥假体固定,术后1年出现髋臼假体松动。行二期翻修术。Harris评分术前平均41．3分,术后平均83．5分。结论①无菌性松动和医源性错误是人工髋关节翻修的最常见原因;②髋臼翻修首选非骨水泥假体生物型固定,对于包容性髋臼骨质缺损,应行颗粒打压植骨＋非骨水泥臼固定;（蓼翻修术中股骨柄取出困难可行股骨大粗隆延长截骨;④术后功能锻炼至关重要。     

3D打印辅助髋臼金属支架在老年髋臼骨缺损翻修中的应用

目的 探讨3D打印辅助髋臼金属支架在老年髋臼骨缺损翻修中的应用效果。方法 采用3D打印辅助髋臼金属支架搭配骨水泥翻修治疗18例老年髋关节置换术后髋臼骨缺损患者。术前应用3D打印机按1∶1比例打印骨盆模型。股骨柄翻修:5例采用生物型股骨假体柄,7例采用骨水泥型股骨假体柄,6例保留原股骨假体柄。结果 患者均获得随访,时间8～19个月。术后切口均一期愈合。末次随访时,髋臼假体位置合适,无松动及脱位,髋关节疼痛症状明显缓解或消失,髋关节Harris评分为86～93分。结论 采用3D打印辅助髋臼金属支架搭配骨水泥行老年髋臼骨缺损翻修,髋臼假体可获得即刻的初始稳定,无需植骨,近期疗效满意。     

应用解剖型骨水泥股骨假体结合冻干骨打压植骨进行髋关节翻修

[目的]探讨结合应用解剖型骨水泥股骨假体和冷冻干燥颗粒骨打压植骨(IBG)进行股骨翻修的可行性及临床效果。[方法]作者在2001年1月～2005年12月期间,在髋关节翻修中,有49例在股骨翻修中应用解剖型骨水泥柄结合冷冻干燥颗粒骨打压植骨技术,其中有36例(73%)存在严重的骨缺损(Paprosky分型ⅢB或Ⅳ)。平均随访时间为35.3个月(26～52个月)。通过Harris评分和X线片对结果进行评价。[结果]Harris评分从术前的平均44.6分提高到最后评估时的平均88.3分,Harris评分优良率为89.8%。X线片未显示有明显的股骨假体下沉。1例出现术后感染,1例出现术后脱位,感染率及脱位率均为2%,3例出现了术中股骨骨折及股骨柄穿孔,其发生率为6.1%,但这些与假体及植骨材料选择无关。[结论]使用解剖型骨水泥股骨假体结合异体冷冻干燥颗粒骨打压植骨技术,对有严重骨缺损的股骨进行翻修是可行的,并且中短期的临床效果满意,长期效果还有待观察。     

非骨水泥长柄假体结合同种异体颗粒骨植骨在股骨翻修骨缺损重建中的应用

目的 回顾性分析股骨髓内同种异体颗粒骨打压植骨结合非骨水泥长柄假体在髋关节翻修术中股骨侧骨缺损修复应用的近期临床效果.方法 2003年7月至2009年6月对27例股骨侧骨缺损患者采用同种异体颗粒骨打压植骨,其中男性15例,女性12例,年龄47～78岁,平均67岁.失败原因:骨溶解、无菌性松动20例,全髋关节置换术后假体周围感染二期翻修7例.按Paprosky分型标准,Ⅱ型骨缺损3例,Ⅲ型骨缺损2l例,Ⅳ型骨缺损3例.术中均采用同种异体颗粒骨打压植骨、非骨水泥翻修柄植入.定期随访复查,包括临床、影像学评估,观察假体有无松动、下沉,植入骨活化替代情况以及假体周围骨折等并发症.Harris评分术前平均43分(37～62分).结果 23例患者获得随访,随访时间3～47个月,平均26.4个月.术后末次随访时.Harris评分平均83分(67～97分).术中2例发生股骨大转子骨折,无一例发生术后假体周围骨折等并发症.1例术后发生关节脱位,1例发生深静脉血栓,1例术后2周发生急性感染,经扩创、置管冲洗、抗感染治疗成功保留假体;发生异位骨化1例,Brooker Ⅰ级.影像学所有患者股骨柄中置,无内翻或外翻,随访期内无一例发生股骨柄移位(内翻或外翻角度变化>3°).23例患者显示至少Ⅰ区股骨髓内移植骨与周围骨或与股骨柄整合.4例发生股骨柄假体下沉,平均下沉3.3 mm(2～6 mm).结论 股骨侧翻修中,良好的股骨髓内同种异体颗粒骨打压植骨结合合适的非骨水泥延长柄股骨假体,可以修复关节置换术后各种原因所导致股骨骨缺损、重建股骨完整性,具有很好的近期临床疗效.但中远期临床效果尚待进一步观察.     

金刚砂喷涂直锥形非骨水泥钛假体柄在55岁以下患者的应用：15～20年随访结果

全髋置换术应用于年轻患者常采用非骨水泥假体。作者分析了55岁以下全髋置换141例（154髋）,采用金刚砂喷涂直锥形非骨水泥钛假体柄和螺旋髋臼杯,随访15～20年。结果显示：41例假体柄过小,其中4例10年后松动,因疼痛而行翻修术;5例因假体周围骨折而翻修;7例见股骨近端溶解但没有症状。20年成功率达到90%。随访中67例髋臼杯进行了翻修。     

定制肿瘤型关节假体髓外柄断裂的有限翻修技术

 目的 介绍定制肿瘤型关节假体髓外柄断裂的有限翻修方法,并评价其临床应用效果。方法 3例患者行定制肿瘤型关节假体置换术后发生假体髓外柄断裂,男2例,女1例;年龄分别为25岁、51岁和52岁。原发肿瘤部位及病理组织学类型分别为股骨远端骨肉瘤、股骨远端复发性骨巨细胞瘤及股骨近端软骨肉瘤。假体髓外柄断裂分别发生于术后11个月、34个月和28个月,均无明显外伤史,为行走时发生假体断裂。假体断裂处位于股骨远端假体髓外柄结合部和股骨近端假体的股骨颈基底部。依据假体断裂后髓内柄固定牢固及髓外柄残留足够长度的情况,为避免常规翻修手术中较困难的原假体髓内柄及骨水泥取出,设计了股骨近端和远端翻修假体进行有限翻修,该翻修假体由套筒部和关节部组成,材质及关节部外形与原假体相同,翻修时保留原假体髓内柄,将翻修假体套接于残留的髓外柄,骨水泥及挤压螺钉固定,同时更换磨损的配件,从而完成有限翻修。术后常规功能锻炼,定期随访观察翻修假体稳定性及肢体功能恢复情况。结果 3例患者假体断裂原因为股骨远端假体髓外柄结合部、股骨近端假体股骨颈基底部疲劳断裂各1例,股骨远端假体髓外柄结合部松动、锁钉断裂1例。翻修术后分别随访1个月、103个月和110个月,1例骨巨细胞瘤患者发生软组织内肿瘤复发而再行肿瘤切除术。至末次随访时,3例患者翻修假体固定牢固、无松动。MSTS评分肢体功能评分分别为66.7%、86.7%和83.3%。结论 定制肿瘤型关节假体由于疲劳或结构失效可发生断裂,套接式翻修假体可保留固定牢固的原假体髓内柄而行有限翻修,降低了手术难度,有利于肢体功能的尽快恢复。     

非骨水泥型髋假体进行髋关节翻修的四年随访研究

目的　评价非骨水泥型髋关节系统治疗人工全髋关节翻修术的术后中期临床随访效果。方法　自1996年11月至2001年1月,对55例56髋关节行翻修术,采用了Zweymüller非骨水泥人工髋关节系统,年龄30~80岁,平均59岁。均有至少两年以上的临床和放射学追踪资料,平均随访时间4年。结果　32例32髋得到随访, 23例24髋失访。有3例出现围手术期并发症: 1例为假体取出时大转子骨折, 1例为术后2d脱位并成功闭合复位, 1例为伤口深部感染需要再次清创。无髋臼及股骨柄假体需要再度翻修。Harris评分由术前平均40 6分提高到最末次随访平均80 4分。X线片示髋臼和股骨柄假体位置满意,无松动和感染征象,周围骨质内向长入。结论　中期临床结果显示,初次用骨水泥和非骨水泥固定人工髋关节置换失败的病例,若髋臼环完整,使用非骨水泥型髋关节假体可以获得良好的临床效果。     

半髋柄固定方式对高龄股骨颈骨折疗效的影响

目的探讨半髋置换股骨柄在股骨近端髓腔不同形态固定方式对高龄股骨颈骨折疗效的影响。 方法回顾分析2007年1月至2017年2月在东莞市人民医院关节外科分别连续收治的75岁以上高龄股骨颈骨折患者100例,纳入标准：Garden Ⅲ、Ⅳ型、骨折前尚能独立行走;排除标准：股骨颈病理性骨折、同侧髋骨关节炎、严重内科疾病不能耐受手术。分为骨水泥组和生物组。骨水泥组行骨水泥股骨柄双动头置换术,生物组行生物双动头置换术,对比骨水泥组与生物组术中并发症,术后假体周围骨折情况,股骨近端髓腔Noble分型,股骨假体的初始位置,假体松动情况及其末次随访时的髋关节功能Harris评分差异,计量资料对比采用t检验,计数资料比较采用卡方检验。 结果100例患者均获得随访平均(15 ± 3)个月。骨水泥组术中出现明显骨水泥反应2例,未出现死亡病例,术后有2例出现假体周围骨折(Vancouver分型VB2型和VC型)。生物组术中出现股骨距骨折6例(Vancouver分型VAL型),术后假体周围骨折2例(Vancouver分型均为B2型),术后3个月内出现髋关节后脱位1例。术后3个月内死亡2例,均为肾功能衰竭患者。股骨柄的位置安放在内或外翻位>3°为异常时,100例中仅生物组1例烟囱型髓腔出现内翻位置达4°,异常率仅为1%。骨水泥型股骨柄容易出现外翻位放置,生物型股骨柄容易出现内翻位放置。术后末次随访髋关节功能Harris评分骨水泥组和生物组优良率分别为89%和83%,两组差异无统计学意义(χ²＝0.44,P>0.05)。 结论生物无领矩形股骨柄(LCU股骨柄)与有领骨水泥股骨柄(Classic股骨柄)双动头置换治疗高龄股骨颈骨折患者在股骨近端不同类型的髓腔中均能获得良好的治疗效果。     

大转子延长截骨在股骨柄翻修术中的应用

目的 报道大转子延长截骨在股骨柄翻修术中的应用及其疗效。方法 从 1998年 1月～ 2000年 1月,采用大转子延长截骨术取出股骨柄、骨水泥,行翻修术 11例。男 7例,女 4例。年龄 53～ 69岁,平均 65.4岁。翻修原因 :股骨柄断裂 2例,人工股骨头置换术后髋臼骨关节炎 8例,假体位置异常 1例。结果 11例患者术后第 2 d均在助行器辅助下下床行走,术后 3个月大转子延长截骨处临床愈合后,改扶单拐行走, 6个月后弃拐行走。术后随访 6～ 30个月,大转子延长截骨处骨性愈合, Harris评分平均为 89.6分。结论 大转子延长截骨术多用于翻修术中取出固定牢固的骨水泥或非骨水泥假体柄。其适应证包括 :(1)股骨柄近端断裂,远端仍牢固固定者; (2)人工股骨头置换术后发生髋臼骨关节炎伴髋关节强直,股骨柄固定牢固,需行全髋翻修者; (3)股骨柄安放位置错误,但骨水泥固定良好者; (4)不伴有假体松动的早期严重感染需行翻修者。该方法显露充分,术后恢复快,是一种较好的股骨柄固定牢固的翻修方法。主要并发症有截骨处不愈合、移位及截骨片骨折。     

Outcome of revision for mechanical stem failure using the cemented Charnley's stem: A Study of 399 Cases

Three hundred ninety-nine cemented stem revision total hip arthroplasties performed in cases with mechanical stem failure without infection and having a minimum follow-up period of 3 years were prospectively studied. Two hundred eighty-three were revised for aseptic stem loosening and 116 were revised for fractured stem. Bone-grafting was not performed in any of the cases. The average follow-up period was 7 years 5 months. At the last follow-up evaluation, 70.4% of the patients were pain free and 20.6% had only mild or occasional discomfort. On radiographic evaluation, 31 stems (7.8%) were loose. Thirty-five hips (8.8%) required a rerevision, of which only 20 (5.0%) were for recurrence of mechanical stem failure. Clinical survivorship of the revised stem was 93.9% at 10 years, whereas radiographic survivorship was 91.5% at 10 years. On radiographic analysis, the mechanical failure rate at the last follow-up evaluation was greater after revision for fractured stem than after revision for aseptic stem loosening. Prerevision femoral cortical bone stock did not appear to adversely affect the outcome of the procedure. The clinical and radiologic results achieved with cemented stem revision arthroplasty for mechanical stem failure are excellent.     

Excellent results with femoral revision surgery using an extensively hydroxyapatite-coated stem: 59 patients followed for 10-16 years

BACKGROUND: The outcome of femoral component revision with either cemented or proximally coated stems has been disappointing, but revision with extensively coated stems has been promising. We report long-term outcome of a grit-blasted titanium stem entirely plasma sprayed with hydroxyapatite (HA), in femoral revision surgery. PATIENTS AND METHODS: During 1988 to 1993, we performed 66 femoral revisions in 65 patients (49 women) aged mean 58 (28-86) years. 3 patients died before the 10-year follow-up and 4 did not come for the follow-up examination because they had no hip problems, as confirmed by telephone and by a written reply. 1 of these, however, was previously controlled at 10 years. Thus, 59 patients (60 hips) were followed by clinical and radiographic analysis for 10-16 years after femoral stem revision. RESULTS: 1 stem was re-revised due to mechanical failure, and none were revised because of infection. We noticed a low degree of proximal bone loss and a low incidence of distal bone hypertrophy. These observations indicate no significant net transfer of stress proximally to distally, and a somewhat physiological weight distribution from the stem to the femoral bone. The bone changes confirmed a well-fixed femoral component in asymptomatic patients. INTERPRETATION: Our findings indicate good long-term results with a fully HA-coated stem in femoral revision surgery.     

Long-Term Survival of the Cemented Exeter Universal Stem in Patients 50 Years and Younger: An Update on 130 Hips

BackgroundThere is variable evidence regarding survivorship beyond 20 years of total hip arthroplasties in young patients. We report the long-term results of the Exeter cemented hip system in patients ≤50 years at minimum of 20 years.MethodsClinical and radiological outcomes of 130 consecutive total hip arthroplasties in 107 patients aged 50 years or younger at primary operation were reviewed; 77% had a diagnosis other than osteoarthritis. All patients were followed at 5-year intervals, no patients were lost to follow-up, and the status of every implant is known.ResultsMean age at surgery was 41.8 (17-50) years. Mean follow-up was 22.0 (20.0-26.1) years. There were 79 hips surviving, 14 hips (11 patients) deceased, and 37 hips revised. Reasons for revision: 29 hips for aseptic cup loosening (26 stems revised using cement-in-cement, three left in-situ); three stems for femoral osteolysis, two related to acetabular polyethylene wear (14.1 and 17.0 years), one with Gaucher’s disease (21.1 years); one broken stem (12.9 years); one cup for instability (4.3 years–stem revised using cement-in-cement); and two hips with infection (8.5 and 23.8 years). There were no cases of aseptic loosening of the Exeter stem. There were no radiologically loose stems although eight patients had radiological evidence of loosening of the cemented cup. Survivorship at 22 years was 74.9% for revision for all causes and 96.3% for revision of the stem for aseptic loosening or lysis.ConclusionThe Exeter cemented stem has excellent survivorship at minimum 20 years in young patients. Acetabular component survivorship was less favorable, but the advent of highly cross-linked polyethylene may improve this in the long term.     

Excellent results with femoral revision surgery using an extensively hydroxyapatite-coated stem: 59 patients followed for 10-16 years

Background The outcome of femoral component revision with either cemented or proximally coated stems has been disappointing, but revision with extensively coated stems has been promising. We report long-term outcome of a grit-blasted titanium stem entirely plasma sprayed with hydroxyapatite (HA), in femoral revision surgery.

Patients and methods During 1988 to 1993, we performed 66 femoral revisions in 65 patients (49 women) aged mean 58 (28-86) years. 3 patients died before the 10-year follow-up and 4 did not come for the follow-up examination because they had no hip problems, as confirmed by telephone and by a written reply. 1 of these, however, was previously controlled at 10 years. Thus, 59 patients (60 hips) were followed by clinical and radiographic analysis for 10-16 years after femoral stem revision.

Results 1 stem was re-revised due to mechanical failure, and none were revised because of infection. We noticed a low degree of proximal bone loss and a low incidence of distal bone hypertrophy. These observations indicate no significant net transfer of stress proximally to distally, and a somewhat physiological weight distribution from the stem to the femoral bone. The bone changes confirmed a well-fixed femoral component in asymptomatic patients.

Interpretation Our findings indicate good long-term results with a fully HA-coated stem in femoral revision surgery. ▪     

Gute langfristige Nachuntersuchungsergebnisse einer zementierten Titan-Geradschaftprothese

A higher-than-average rate of aseptic loosening has been postulated to be associated with the combination of a titanium stem and bone cement. In this prospective follow-up study we therefore investigated our first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (BiCONTACT((R)), Aesculap, Tuttlingen, Germany).Average time of follow-up evaluation was 9.7 years (range 8.7-10.3 years). At follow-up, mean patient age was 81 years; 89 patients with 93 hips have deceased and two could not be located. Follow-up rate was 98.7% for the patients still alive at time of follow-up evaluation. Five patients have been revised, two for infection and one for aseptic loosening of a varus-malaligned stem; two radiologically well-fixed stems had been revised during acetabular revision. Survival estimate showed a calculated cumulative survival rate of 97.5% after 11 years [confidence limits: 99.0% (upper) and 94.1% (lower)]. The average Harris hip score at time of follow-up was 82.25 points.Radiologically, signs of loosening could be detected in 3 stems: in one case varus malalignement deteriorated with time and in 2 cases osteolyses developed together with significant polyethylene wear. All 3 patients experienced only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated to the combination of titanium and cement in this specific stem. Design parameters seem to play an important role in the development of aseptic loosening in cemented titanium stems.     

Outcomes of Long Tapered Hydroxyapatite-Coated Stems in Revision Total Hip Arthroplasty

The purpose of this study was to evaluate the outcome of femoral component revisions using a long tapered HA coated femoral revision stem. Between 2001 and 2008, 55 femoral component revisions were performed using this stem. Forty-one patients were available for follow up evaluation at average of 59 months. The clinical results were evaluated using the HHS and serial radiographs were evaluated for loosening. The mean HHS was 71 (range 22–100). Three hips required revision of KAR stem (1 aseptic loosening, 1 infection, 1 limb length discrepancy). Only one prosthesis demonstrated radiographic evidence of subsidence. Our study suggests that long tapered HA coated revision femoral components can provide stable fixation and in-growth in cases where there is good proximal femoral bone stock and favorable canal geometry.     

18 years of results with cemented primary hip prostheses in the Norwegian Arthroplasty Register: Concerns about some newer implants

Background and purpose Few studies have compared the long-term survival of cemented primary total hip arthroplasties (THAs), and several prostheses have been used without adequate knowledge of their endurance. We studied long-term outcome based on data in the Norwegian Arthroplasty Register.Patients and methods The 10 most used prosthesis brands in 62,305 primary Palacos or Simplex cemented THAs reported to the Register from 1987 through 2007 were included. Survival analyses with revision as endpoint (for any cause or for aseptic loosening) were performed using Kaplan-Meier and multiple Cox regression with time-dependent covariates. Revision rate ratios (RRs) were estimated for the follow-up intervals: 0–5, 6–10, and > 10 years.Results 5 prosthesis brands (cup/stem combinations) (Charnley, Exeter, Titan, Spectron/ITH, Link IP/Lubinus SP; n = 24,728) were investigated with 0–20 year follow-up (inserted 1987–1997). After 18 years, 11% (95% CI: 10.6–12.1) were revised for any cause and 8.4% (7.7–9.1) for aseptic loosening. Beyond 10 years of follow-up, the Charnley cup had a lower revision rate due to aseptic loosening than Exeter (RR = 1.8) and Spectron (RR = 2.4) cups. For stems, beyond 10 years we did not find statistically significant differences comparing Charnley with Titan, ITH, and SP stems, but the Exeter stem had better results (RR = 0.5). 10 prosthesis brands (9 cups in combination with 6 stems; n = 37,577) were investigated with 0–10 years of follow-up (inserted from 1998 through 2007). The Charnley cup had a lower revision rate due to aseptic loosening than all cups except the IP. Beyond 5 years follow-up, the Reflection All-Poly cup had a 14 times higher revision rate. For stems, beyond 5 years the Spectron-EF (RR = 6.1) and Titan (RR = 5.5) stems had higher revision rates due to aseptic loosening than Charnley. The analyses also showed a marked improvement in Charnley results between the periods 1987–1997 and 1998–2007.Interpretation We observed clinically important differences between cemented prosthesis brands and identified inferior results for previously largely undocumented prostheses, including the commonly used prosthesis combination Reflection All-Poly/Spectron-EF. The results were, however, satisfactory according to international standards.     

髓内打压植骨结合广泛多孔涂层长柄假体在股骨侧严重骨缺损（PaproskymA型）翻修术中的应用

目的 探讨股骨侧严重骨缺损（Paprosky ⅢA型）翻修中应用髓内打压植骨结合广泛多孔涂层长柄假体的临床疗效.方法 2006年3月～2010年9月,对38例（38髋）Paprosky ⅢA型股骨骨缺损患者行翻修重建,其中男24例,女14例,平均年龄62岁.翻修原因：骨溶解、无菌性松动29例,全髋关节置换术（THA）术后感染二期翻修6例,假体周围骨折3例（Vancouver B3型）.股骨侧干骺端骨缺损采用同种异体颗粒骨髓腔内打压植骨进行修复,股骨柄采用全涂层长柄假体（7～10英寸）.术后定期随访,髋关节功能评价采用Harris评分,影像学采用X线片及CT观察：假体柄有无松动下沉、股骨近端应力遮挡情况、植入的异体颗粒骨与宿主骨整合情况.结果 38例均获得随访,平均随访53.4个月（23～62个月）,Harris评分由术前平均42分（32～47分）,提高至末次随访时平均86分（69～95分）.无患者发生脱位、假体周围骨折.1例术后感染,行再次二期翻修;1例假体柄在术后6个月内下沉4.24 cm,再次翻修时选择更粗的假体柄,末次随访时假体柄稳定;其余所有患者假体柄均牢固固定.3例出现轻-中度应力遮挡.15例近端皮质骨密度及厚度有增加,厚度平均增加约1.8 mm（0.7～3.5 mm）,植入骨与宿主骨逐渐整合并增加了骨缺损区的骨质储备.结论严重骨缺损（Paprosky ⅢA型）的股骨翻修中,采用髓内颗粒骨打压植骨可以很好的修复股骨中上段骨缺损,重建股骨干骺端.依靠广泛多孔涂层长柄假体在远端的牢固压配固定,结合股骨干骺端髓内紧密打压植骨,使假体柄在股骨中上段及远端均能获得较好的初始稳定性,近期临床和影像学结果满意,远期疗效有待观察.     

Revision of cemented hip arthroplasties: 101 hips followed for 5 (4-9) years

101 hips were revised with cemented Lubinus prostheses after failed primary cemented arthroplasty, and followed for 5 (4-9) years. Radiographically, 41 hips (36 femoral stems and 13 acetabular components) had become loose. The use of an intramedullary plug at the revision did not prevent sinking of the prosthesis. No difference was found between conventional or pressure-injection cementation techniques. In cases where the stem was inserted in varus or the acetabular component was in malposition there was increased loosening. Patients below 50 years of age had oftener more than 5 mm sinking of the stem and more prosthesis loosenings.     

Results of a cemented straight titanium alloy femoral stem after mean follow-up of 13 years

The first consecutive series of 250 implantations of a cemented femoral shaft prosthesis made of titanium alloy (Bicontact®, Aesculap, Tuttlingen, Germany) in 239 patients are included in this prospective follow-up study. Average time of follow-up evaluation was 12.6 years (range 11.8–13.8 years). At follow-up, 116 patients with 112 hips have died and only two could not be located. Follow-up rate was 99.2% for the patients still alive at time of follow-up evaluation. Eight patients have been revised, two for infection, one for aseptic loosening of a varus-malaligned stem and two for aseptic loosening in cases with osteolysis; two radiologically well-fixed stems had been revised during acetabular revision. Two additional stems were regarded loose according to radiologic criteria. Survival estimate (with revision as an endpoint) showed a calculated cumulative survival rate of 95.8% after 14 years [confidence limits: 98.0% (upper) and 91.4% (lower)]. The average HARRIS hip score at time of follow-up was 77.3 points. Radiologically, signs of loosening could be detected in two stems: in both cases osteolyses developed together with significant polyethylene wear. One of these patients experienced severe pain, so an indication for revision is given, the other has only mild pain and revision had not been indicated so far. In conclusion, the long-term follow-up results with this cemented titanium femoral component are encouraging and are comparable to other successful cemented femoral components in primary total hip arthroplasty. No increased risk for aseptical loosening was associated with the combination of titanium and cement in this specific stem.