Design features and clinical results of anatomic femoral stem in total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2014.40.006

Abstract

Abstract:

BACKGROUND: Ribbed anatomic femoral stem meets the biomechanical features of the femur, and has achieved satisfactory clinical efficacy with good initial stability, rapid bone growth and low stress shielding.

OBJECTIVE: To evaluate the design features and clinical results of the cementless anatomic Ribbed femoral stem (Ribbed stem) in total hip arthroplasty.

METHODS: We retrospectively analyzed 52 patients (52 hips) with hip joint disease who were treated with Ribbed stem in total hip arthroplasty between March 2010 and March 2012. There were 20 males and 32 females. The mean age was 59 years (range 22-78 years). The mean follow-up was 3.1 years (range 2-4 years). The preoperative and postoperative Harris hip scores, the rate of postoperative thigh pain, the incidence of intraoperative femoral fracture, wound healing, dislocation and revision were recorded. Radiographic evaluation was used to evaluate the rate of stem fill, subsidence of femoral stem, periprosthetic radiolucent line, bone ingrowth, stress shielding, and osteolysis.

RESULTS AND CONCLUSION: The incidence of intraoperative femoral fracture was 6%. All incisions were healed. There were no cases of hip dislocation and revision; the rate of thigh pain was 6%, no patient had thigh pain after 1 year postoperatively. The mean preoperative Harris hip score was 48 points, which improved to a mean of 96 points at the final follow-up. Postoperative X-ray showed that all patients had a satisfactory femoral fill in both planes and all of the femoral stems were well-fixed at the final follow-up. The average filling rate was 91%, 88% and 86% by normotopia imaging, while 88%, 85% and 81% by lateral imaging, at the metaphysic, middle and distal ends respectively. At the final follow-up, 49 hips (92%) showed stable bone ingrowth, 3 hips showed stable fiber ingrowth. No osteolysis around the components at the femur or acetabulum was observed. 5 (10%) hips appeared the subsidence of femoral stems, which were < 2 mm. The stress shielding phenomenon occurred in all patients, including first-degree in 31 hips, second-degree in 19 hips, third-degree in 2 hips, and fourth-degree in no case. Experimental findings indicate that, Ribbed stem with a rational design can achieve satisfactory clinical outcomes with good initial stability, rapid bone growth and low stress shielding.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: arthroplasty, replacement, hip, hip prosthesis, prosthesis design, follow-up studies

CLC Number:

R318

Jiang Tao, Sun Jun-ying, Zha Guo-chun, You Zhen-jun, Wang Tao. Design features and clinical results of anatomic femoral stem in total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6425-6431.

Figures/Tables 1

2.1 参与者数量分析按照意向性处理，截止随访末期，52例应用Ribbed柄全髋关节置换的患者均进入结果分析，无脱落。 2.2 临床疗效术中出现股骨骨折3例，所有骨折均获骨性愈合。平均Harris评分由置换前48分(18-63分)提高到末次随访时96分(71-100分)；置换后3例(6%)出现大腿痛(2例轻度、1例中度疼痛)，但均于置换后1年消失。末次随访时，术中发生骨折患者与未发生骨折患者的Harris评分差异无显著性意义(P > 0.05)。 2.3 影像学结果置换前X射线片显示股骨髓腔类型：Dorr A型41髋(79%)、Dorr B型5髋(10%)、Dorr C型6髋(12%)。置换后即刻X射线片示：股骨假体中立位46髋(89%)、内翻(< 4°)2髋(4%)、外翻(< 4°)4髋(8%)；所有患者股骨髓腔充填满意，平均充填率：正位片上干骺段、中段和远段分别为91%，88%和86%，侧位片上干骺段、中段和远段分别为88%，85%和81%；髋臼杯平均外展角和前倾角分别为41° (31°-51°)和14°(7°-19°)。采用陶瓷对陶瓷摩檫界面45髋(均采用BETA髋臼杯)，聚乙烯对陶瓷界面7髋(均采用T.O.P髋臼杯)，36 mm股骨头35髋，28 mm股骨头17髋。陶瓷均为德国CeramTec公司生产的第4代纳米复合陶瓷(Biolox Delta)，随访中无陶瓷碎裂。末次随访时，49髋(92%)为稳定性骨性长入固定(点焊征位于2区28髋、3区8髋、5区9髋、6区19髋)，3髋为稳定性纤维长入固定。股骨和髋臼假体均未观察到连续性X射线透亮线。髋臼侧，1髋(2%)显示宽度为0.7 mm的不连续X射线透亮线，位于Ⅱ区；股骨侧，8髋(15%)在假体周围显示宽度< 2 mm的不连续X射线透亮线，其中Ⅰ区5髋、Ⅱ区1髋、Ⅲ区2髋、Ⅶ区7髋。股骨侧和髋臼侧假体周围均未显示骨溶解。末次随访时，5髋(10%)发生股骨柄假体下沉(Dorr A型1髋、Dorr B型3髋、Dorr C型1髋)，但无一髋显示下沉>2 mm；所有患者均出现不同程度的应力遮挡现象，其中1度31髋、2度19髋、3度2髋，无4度应力遮挡发生。共9髋(17%)出现异位骨化，其中1度5髋，2度4髋，未出现3度或4度异位骨化。 2.4 典型病例女性患者，52岁，左髋关节疼痛活动受限，诊断为左先天性髋关节脱位，患者采用Ribbed股骨柄假体置入治疗，随访4年，假体位置良好，无松动表现(图4)。 2.5 不良事件纳入患者术中出现股骨骨折3例(6%)，1例发生于股骨近段扩髓时，另2例发生于安装假体时。3例骨折中，1例为股骨大转子骨折(采用钢丝捆扎)，余2例均发生于股骨矩，其中Mallory Ⅰ型骨折1例(无需钢丝捆扎)、Mallory Ⅱ型骨折1例(采用钢丝捆扎)、未发生Mallory Ⅲ型骨折；术中未出现骨皮质穿透性骨折或股骨干部骨折；包括转子下截骨1例；所有骨折均获骨性愈合。未出现感染、脱位和神经血管损伤等并发症。"

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