Uncemented prosthesis revision of failed cemented hip arthroplasty: mid-term results

doi:10.3969/j.issn.2095-4344.2015.04.004

Abstract

Abstract:

BACKGROUND: The uncemented prosthesis in primary total hip arthroplasty has obtained good outcomes, but its application in revision especially in failed cemented hip arthroplasty deserves further investigations.
OBJECTIVE: To observe the mid-term results of uncemented revision of failed cemented hip arthroplasty.
METHODS: 41 patients (47 hips) with uncemented revision of failed cemented hip arthroplasty were followed up from November 1997 to February 2013. In the 47 hips, 24 hips replaced the cemented stem component while 23 hips underwent the cemented acetabular revision. Prosthesis change was observed in radiographs. Harris functions were evaluated and prosthesis survival rate was analyzed.
RESULTS AND CONCLUSION: A total of 33 patients (38 hips) were followed up for 1.3-14.8 years. The mean preoperative Harris hip score increased from 34 (range, 11-66) points to 85 (range, 55-94) points at the time of final follow-up (P < 0.01). 36 hips (95%) had an excellent stability. Osteolysis and migration of the prosthesis were seen in 2 hips (1 in acetabulum and 1 in femur), which needed re-revision. Heterotopic ossification developed in 9 hips (24%). The mean polyethylene liner wear was 0.08 mm (range, 0-0.25 mm) per year. The wear rate only correlated with changes of abduction angle of the acetabulum (P < 0.01). Imaging verified that loosening served as a failure criterion. Kaplan-Meier survival analysis was used to calculate uncemented prosthesis for 7 years and showed that total survival rate was 89%. The survival rates of acetabular prosthesis and femoral prosthesis were respectively 93% and 92%. Results indicated that uncemented prosthesis could deal with the problem of bone deficiency and obtain satisfactory mid-term clinical results in revision of failed cemented hip arthroplasty.

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, Prosthesis Implantation, Follow-Up Studies

CLC Number:

R318

Li Peng, Zhu Zhi-qi, Hou Ming, Shi Zhan-jun. Uncemented prosthesis revision of failed cemented hip arthroplasty: mid-term results [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 510-515.

Figures/Tables 2

2.1 参与者数量分析纳入行人工髋关节翻修的41例47髋患者中33例38髋得到完整随访资料，末次随访前死亡4例4髋(均与关节置换术无关)，失访4例5髋，随访时间1.3-14.8年。 2.2 临床评估结果手术平均耗时159 min，术中平均出血量为1 020 mL，输血761 mL，术后给予抗生素常规治疗3-5 d。髋臼侧行髋臼加强环重建的患者在术后早期扶拐进行非负重锻炼，其余患者均于术后3 d开始逐渐下地进行负重功能锻炼。大于40岁的患者术后常规使用低分子肝素抗凝预防深静脉栓塞，未采取任何措施预防术后异位骨化。患者平均住院24 d。在获得随访的33例38髋中，患者的平均Harris评分由术前的34分(11-66分)增加到末次随访时的85分(55- 94分)，两者比较差异有显著性意义(P < 0.01)；末次随访时目测类比评分平均为2.4分(0-7分)；术后平均弃拐时间为3.2个月。术前所有患者均有中-重度疼痛，末次随访时，25髋无疼痛，9髋时有隐痛，轻度疼痛3髋，中度疼痛1髋。末次随访时，所有患者血沉、C-反应蛋白、血常规检查正常，局部软组织无肿胀和压痛。未出现症状性深静脉血栓或神经损伤。 2.3 并发症本组患者1例行Muller型髋臼加强环翻修后3年发生深部感染性松动行2期再翻修，再翻修后4年随访假体稳固，感染未复发(图1)。1例患者股骨假体远端穿出股骨皮质而需再翻修，但患者无任何临床症状，拒绝再翻修(图2)。 2.4 放射学评估 33例38髋获得完整的影像学资料，其中36髋(95%)假体获得良好稳定性，未发生固定物松动、下沉及植骨吸收。1髋在髋臼2，3区出现髋臼骨溶解并假体移位而需要再翻修(图1)，1例患者股骨假体远端穿出股骨皮质，且在股骨1区出现透亮线而需再翻修(图2)。9髋(24%)发生异位骨化，其中Brooker1级2髋，2级4髋，3级3髋。聚乙烯衬垫平均磨损0.28 mm(0.02-0.87 mm)，年平均磨损量为0.08 mm(0-0.25 mm)。磨损量与性别、体质量、身高均无相关性，仅与外展角变化有关(P < 0.01)。 2.5 典型病例典型病例翻修前后的X射线片见图3，4。 2.6 统计学结果 Kaplan-Meier生存分析表明，将放射学上证明假体松动而需要翻修作为失败的标准时，非骨水泥假体术后7年存活率为0.89(95%CI，0.81-0.97)，其中髋臼假体和股骨假体的存活率分别为0.93(95%CI，0.87-0.99)和0.92(95%CI，0.85-0.99)，见图5。"

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