Early follow-up of total hip arthroplasty with Accolade TMZF cementless femoral prosthesis

doi:10.3969/j.issn.2095-4344.2015.17.003

Abstract

Abstract:

BACKGROUND: Compared with the fixation of bone cement prosthesis, the fixation of cementless femoral prosthesis does not have the following worries, including cement-prosthesis separation, cement sheath rupture, and cement debris-induced osteolysis. Long-term outcomes are good, and the survival rate is high.

OBJECTIVE: To observe the preliminary clinical results and complications of total hip arthroplasty with Accolade TMZF cementless femoral stem.

METHODS: From February 2010 to July 2012, 67 patients (70 hips) underwent primary total hip arthroplasty with cementless femoral stem. All patients were treated with Accolade TMZF Biological hip prosthesis system. Femoral component was treated with the same Accolade TMZF cementless femoral stem. Acetabular component was treated with Secure-fit HA and Trident PSL HA. The first mortar joint friction surface was treated with ceramic-ceramic composite in 49 hips, ceramic-polyethylene composite in 19 hips and metal-polyethylene composite in 2 hips. After replacement, hip imaging data were utilized to assess biological fixation of femoral stem prosthesis, osteolysis surrounding the prosthesis, and prosthesis subsidence, and to observe hip function, thigh pain and complications.

RESULTS AND CONCLUSION: All cases were followed up for more than 2 years. The mean Harris hip score was (32.7±6.2) preoperatively, and improved to (89.2±5.1) during final follow-up. During final follow-up, four patients (6%) suffered from slight pain. No moderate and severe pain or extremely severe pain occurred. None of the patients needed second operation due to failure for various reasons. X-ray films showed that no prosthesis displacement or loosening. Bone fixation surrounding the prosthesis was visible at the femoral side. Only one hip had subsidence of less than 2 mm, and the remaining did not experience subsidence. No blood vessels or nerve injury appeared during the surgery. During prosthesis placement, femoral calcar cleavage fracture occurred in 4 hips, so wire cerclage was used. Deep vein thrombosis in the lower limb or fractures surrounding the prosthesis was not found after placement. These results indicated that the preliminary clinical results of primary total hip arthroplasty with Accolade TMZF cementless femoral stem are encouraging, can effectively improve the function of hip joint. But the follow-up time is shorter, mid-term long-term curative effect should be further observed.

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, Femur, Bioprosthesis, Follow-Up Studies

CLC Number:

R318

Zhu Yong-sheng, Xu Yao-zeng, Zhu Feng, Wu Guang-peng, Shao Hong-guo. Early follow-up of total hip arthroplasty with Accolade TMZF cementless femoral prosthesis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2637-2641.

Figures/Tables 1

2.1 参与者数量分析纳入接受Accolade TMZF锥形柄股骨假体全髋关节置换的患者69例72髋，置换后失访2例，剩余67例70髋均获得随访。 2.2 随访结果本组病例随访时间24-53个月。患者由置换前Harris髋关节评分平均(32.7±6.2)分改善至末次随访时(89.2±5.1)分。末次随访时大腿轻度疼痛4例(6%)，无中重度疼痛者。本组病例未见感染、脱位或神经血管损伤等翻修并发症。术中因假体置入时造成股骨距劈裂骨折而采用钢丝环扎4髋，置换后未见假体周围骨折患者。本组患者关节置换后功能恢复良好，大多数患者置换后第2天即可抬高患侧肢体，置换后5-7 d即可扶双拐或助行器下地行走。置换后3-7 d行首次摄片检查假体的置入情况，显示所有患者置换后股骨柄近端涂层区域压配良好，在正侧位X射线片上股骨假体位于中立位，髓腔填充良好。置换后3-6个月近端涂层区域出现典型的骨锚固征，按Engh评定标准全部患者在置换后平均4个月获得骨性固定。终末随访时所有假体在髓腔内的位置无改变，假体周围出现广泛骨长入，均为骨性固定。X射线均未出现髋臼侧透光带，股骨侧未出现骨溶解或X射线松动征。股骨柄假体下沉 < 2 mm者1髋(1%)置换后1年内停止继续下沉，余无假体松动下沉。 2.3 典型病例女性患者，43岁，双侧髋关节发育不良伴创伤性关节炎，右髋部骨盆内移截骨术后。一期行右髋部骨盆内移截骨后内固定取出+双侧髋关节置换。随访2年，患者髋关节活动度好，假体位置良好，无松动下沉表现(图4)。 2.4 不良事件有4例患者在假体置入时，股骨距轻微裂纹骨折(6%)，为预防置换后负重而造成骨折进一步向远端延伸，术中采用钢丝环扎。随访过程中，骨折均获得骨性愈合，未出现相关并发症。在随访末期，发现由于应力遮挡以及假体置入时力学形态的改变，股骨大转子部位出现低密度影。"

References

[1]Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597): 1508-1519.
[2]Geesink RG. Osteoconductive coatings for total joint arthroplasty. Clin Orthop Relat Res. 2002;(395):53-65.
[3]Capello WN,D’Antonio JA,Feinberg JR, et al.Ten-year results with hydroxyapatite-coated total hip femoral components in patients less than fifty years old. Aconcise follow-up of a previous report.J Bone Joint Surg(Am). 2003;85:885-889.
[4]D’Antonio JA,Capello WN,Manley MT,et al.Hydroxyapatite Femoral Stems for Total Hip Arthroplasty: 10-to 13-Year Followup.Clin Orthop. 2001;(393):101-111.
[5]Harris WH,Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.J Bone Joint Surg(Am).1969;51(4):737-755.
[6]Petersilge WJ, D’Lima DD, Walker RH, et al．Prospective study of 100 consecutive Harris-Galante porous total hip arthroplasties:4-to 8-year followup study. J Arthroptasty. 1997;12(2): 185-193.
[7]Mulliken.BD,Bourne RB,Rorabeck CH,et al. A tapered titanium femoral stem inserted without cement in a total hip arthroplasty. Radiographic evaluation and stability.J Bone Joint Surg Am. 1996;78(8):1214-1225.
[8]Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;(257): 107-128.
[9]孙俊英,唐天驷,洪天禄,等.巨孔全髋股骨头假体的生物学固定与X线表现[J].中华骨科杂志,1997,17(10):607-610.
[10]Gruen TA, McNeice GM, Amstutz HC. Modes off ailme” of cemented stern-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;(141): 17-27.
[11]Callaghan JJ, Salvati EA, Pellici PM, et al. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982: a two to five-year follow-up. J Bone Joint Surg (Am). 1985;67(7): 1074-1085.
[12]Fang C,Chiu KY,Tang WM, Cementless total hip arthroplasty specifically designed for asians: clinical and radiologic results at a mean of 10 years. J Arthroplasty. 2010;25(6):873-879.
[13]Takenaga RK, Callaghan JJ, Bedard NA, et al. Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up. J Bone Joint Surg Am. 2012; 94(23):2153-2159.
[14]Vidalain JP. Twenty-year results of the cementless Corail stem.Int Orthop.2011;35(2):189-194.
[15]Reitman RD,Emerson R. Thirteen year results of total hip arthroplasty using a tapered titanium femoral component inserted without cementin patients with type C bone. J Arthroplasty. 2003;18(7 Suppl 1):116-121.
[16]Teloken MA, Bissett G, Hozack WJ, et al. Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement. J Bone Joint Surg Am. 2002;84-A(12): 2140-2144.
[17]Cruz-Pardos A, Garcia-Cimbrelo E.The Harris-Galante total hip arthroplasty: a minimum 8-year follow-up study. J Arthroplasty. 2001;16(5):586-597.
[18]Burkart BC, Bourne RB, Rorabeck CH, et al. Thigh pain in cementless total hip arthroplasty. A comparison of two systems at 2 years' follow-up. Orthop Clin North Am. 1993; 24(4):645-653.