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Abstract：
BACKGROUND: The use of long stems for severe femoral bone defects is suggested by many scholars, but it is associated with further bone loss, intraoperative fracture, increased surgical trauma, and complications. With better bone retention, simple and quick surgical procedures, and minimal complications, the short cementless stems with a tapered rectangular shape may be an alternative for femoral revision. This study aimed to evaluate the results of this type of stem in treating selected Paprosky II-IV bone defects.
METHODS: This retrospective study included 73 patients (76 hips involved) who underwent conservative femoral revision using the short cementless stems with a tapered rectangular shape between January 2012 and December 2020. The preoperative femoral bone defects were identified as follows: 54 cases of type II, 11 cases of type IIIA, 7 cases of type IIIB, and 4 cases of type IV. Indications for revision included aseptic loosening (76.3%) and prosthetic joint infection (23.7%). Six cementless stems with a tapered rectangular shape from three companies were used in all patients. Among them, SLR-Plus, SL-Plus MIA, and Corail stems were employed in most patients (40.8%, 23.7%, and 17.1%, respectively). The average length of these stems measured 171.7 mm (SD 27 mm; 122-215 mm). Radiographic results, Harris hip scores (HHS), complications, and survivorship were analyzed. The follow-up lasted for 7 years on average (range 3-11 years).
RESULTS: The subsidence was observed in three hips (3.9%), and all stems achieved stable bone ingrowth. Proximal femoral bone restoration in the residual osteolytic area was found in 67 hips (88.2%), constant defects in nine hips (11.8%), and increasing defects in 0 cases. There was no evidence of stem fractures and stem loosening in this series. The mean HHS significantly improved from 32 (range 15-50) preoperatively to 82 (range 68-94) at the last follow-up (t = - 36.297, P < 0.001). Five hips developed prosthesis-related complications, including three infection and two dislocation cases. The mean 5- and 10-year revision-free survivorships for any revision or removal of an implant and reoperation for any reason were 94.6% and 93.3%, respectively. Both mean 5- and 10-year revision-free survivorships for aseptic femoral loosening were 100%.
CONCLUSIONS: Conservative femoral revision using short cementless stems with a tapered rectangular shape can provide favorable radiographic outcomes, joint function, and mid-term survivorship with minimal complications. Of note, a sclerotic proximal femoral bone shell with continued and intact structure and enough support strength is the indication for using these stems.
METHODS: This retrospective study included 73 patients (76 hips involved) who underwent conservative femoral revision using the short cementless stems with a tapered rectangular shape between January 2012 and December 2020. The preoperative femoral bone defects were identified as follows: 54 cases of type II, 11 cases of type IIIA, 7 cases of type IIIB, and 4 cases of type IV. Indications for revision included aseptic loosening (76.3%) and prosthetic joint infection (23.7%). Six cementless stems with a tapered rectangular shape from three companies were used in all patients. Among them, SLR-Plus, SL-Plus MIA, and Corail stems were employed in most patients (40.8%, 23.7%, and 17.1%, respectively). The average length of these stems measured 171.7 mm (SD 27 mm; 122-215 mm). Radiographic results, Harris hip scores (HHS), complications, and survivorship were analyzed. The follow-up lasted for 7 years on average (range 3-11 years).
RESULTS: The subsidence was observed in three hips (3.9%), and all stems achieved stable bone ingrowth. Proximal femoral bone restoration in the residual osteolytic area was found in 67 hips (88.2%), constant defects in nine hips (11.8%), and increasing defects in 0 cases. There was no evidence of stem fractures and stem loosening in this series. The mean HHS significantly improved from 32 (range 15-50) preoperatively to 82 (range 68-94) at the last follow-up (t = - 36.297, P < 0.001). Five hips developed prosthesis-related complications, including three infection and two dislocation cases. The mean 5- and 10-year revision-free survivorships for any revision or removal of an implant and reoperation for any reason were 94.6% and 93.3%, respectively. Both mean 5- and 10-year revision-free survivorships for aseptic femoral loosening were 100%.
CONCLUSIONS: Conservative femoral revision using short cementless stems with a tapered rectangular shape can provide favorable radiographic outcomes, joint function, and mid-term survivorship with minimal complications. Of note, a sclerotic proximal femoral bone shell with continued and intact structure and enough support strength is the indication for using these stems.
摘要：
背景：许多学者建议使用长杆治疗严重的股骨骨缺损，但它与进一步的骨质流失有关，术中骨折,手术创伤增加,和并发症。有了更好的骨骼保留，简单快捷的外科手术,和最小的并发症，具有锥形矩形形状的短无骨水泥茎可能是股骨翻修的替代方法。这项研究旨在评估这种类型的茎在治疗选定的PaproskyII-IV骨缺损中的结果。
方法：这项回顾性研究纳入了73例患者（76髋），这些患者在2012年1月至2020年12月期间使用锥形矩形的短无水泥茎进行了保守性股骨翻修。术前股骨骨缺损鉴定如下：54例II型，11例IIIA型，IIIB型7例，4例IV型。修订的适应症包括无菌性松动（76.3％）和人工关节感染（23.7％）。所有患者都使用了来自三家公司的六个锥形矩形无骨茎。其中,SLR-Plus,SL-PlusMIA,大多数患者使用了Corail茎（40.8%，23.7%,和17.1%，分别)。这些茎的平均长度测量为171.7mm(SD为27mm;122-215mm)。射线照相结果,哈里斯髋关节评分（HHS），并发症,和幸存者进行了分析。随访时间平均为7年（3-11年）。
结果：在三个臀部观察到沉降（3.9％），所有茎都实现了稳定的骨向内生长。在67髋（88.2%）发现残余溶骨区域的股骨近端骨修复，九个臀部的恒定缺陷(11.8%)，0例增加缺陷。在本系列中，没有证据表明茎骨折和茎松动。平均HHS从术前的32（范围15-50）到末次随访时的82（范围68-94）显着改善（t=-36.297，P<0.001）。五个髋关节出现了假体相关的并发症，包括3例感染和2例脱位。植入物的任何修正或移除以及出于任何原因的再次手术的平均5年和10年无修正生存率分别为94.6％和93.3％，分别。无菌性股骨松动的平均5年和10年无翻修生存率均为100％。
结论：使用具有锥形矩形形状的短无骨水泥茎的保守性股骨翻修术可以提供良好的影像学结果，联合功能，中期生存，并发症最少。值得注意的是，具有连续完整结构和足够支撑强度的硬化股骨近端骨壳是使用这些茎的适应症。
方法：这项回顾性研究纳入了73例患者（76髋），这些患者在2012年1月至2020年12月期间使用锥形矩形的短无水泥茎进行了保守性股骨翻修。术前股骨骨缺损鉴定如下：54例II型，11例IIIA型，IIIB型7例，4例IV型。修订的适应症包括无菌性松动（76.3％）和人工关节感染（23.7％）。所有患者都使用了来自三家公司的六个锥形矩形无骨茎。其中,SLR-Plus,SL-PlusMIA,大多数患者使用了Corail茎（40.8%，23.7%,和17.1%，分别)。这些茎的平均长度测量为171.7mm(SD为27mm;122-215mm)。射线照相结果,哈里斯髋关节评分（HHS），并发症,和幸存者进行了分析。随访时间平均为7年（3-11年）。
结果：在三个臀部观察到沉降（3.9％），所有茎都实现了稳定的骨向内生长。在67髋（88.2%）发现残余溶骨区域的股骨近端骨修复，九个臀部的恒定缺陷(11.8%)，0例增加缺陷。在本系列中，没有证据表明茎骨折和茎松动。平均HHS从术前的32（范围15-50）到末次随访时的82（范围68-94）显着改善（t=-36.297，P<0.001）。五个髋关节出现了假体相关的并发症，包括3例感染和2例脱位。植入物的任何修正或移除以及出于任何原因的再次手术的平均5年和10年无修正生存率分别为94.6％和93.3％，分别。无菌性股骨松动的平均5年和10年无翻修生存率均为100％。
结论：使用具有锥形矩形形状的短无骨水泥茎的保守性股骨翻修术可以提供良好的影像学结果，联合功能，中期生存，并发症最少。值得注意的是，具有连续完整结构和足够支撑强度的硬化股骨近端骨壳是使用这些茎的适应症。
