Femur boyun koruyucu (FBK) protezlerin yol açtığı komplikasyonların analizi

Year 2014, Volume: 48 Issue: 6, 623 - 627, 16.01.2015

Mingqing Li Yihe Hu Jie Xie

https://doi.org/10.3944/AOTT.2014.13.0060

Abstract

Amaç: Bu çalışmanın amacı femur boyun koruyucu (FBK) protez kullanımının, total kalça artroplastisindeki (TKA) klinik ve radyolojik sonuçlarını ve komplikasyonlarını değerlendirmekti.

Çalışma planı: Çalışmada, Ocak 2004 ve Aralık 2011 tarihleri arasında FBK protezi ile TKA uygulanan 125 hastanın (70 erkek, 55 kadın; ortalama yaş: 50, dağılım: 38-60) 142 (82 erkek, 60 kadın) kalçası değerlendirildi. Hasta skorlamaları Harris kalça skoru (HKS) ve görsel analog skala (GAS) ile yapıldı. Radyografiler protez pozisyonu, gevşemesi ve ektopik kemikleşme analizinde kullanılan Gruen bölgeleri ile DeLee ve Charnley bölgelerine göre değerlendirildi.

Bulgular: Ortalama 4.72±2.16 (dağılım:1-8.4) yıllık takip sırasında hiçbir hasta çalışmayı terk etmedi. Cerrahi öncesi 8.3±3.12 olan GAS skoru son takipte 2.1±1.54’e gerilerken, HKS’nin 51.43±4.14 puandan 90.27±6.60 puana geliştiği görüldü. Hastaların %87.4’ünde HKS iyi ve mükemmel olarak değerlendirildi. Brooker sınıflandırmasına göre tamamı Evre 1 olan 4 olguda (%2.8) klinik semptom olmaksızın hafif ektopik kemikleşme izlendi. Beş hastada (%3.5) proksimal femurda kemik kaybı bulundu. Stemi çevreleyen radyolüsen hatlar hiçbir olguda gözlenmedi. Yine hiçbir olguda protez gevşemesi veya femoral protez çökmesi saptanmadı. Femoral ve asetabular komponentler için sağkalım oranı %100 olarak bulundu. Ameliyat sırasında stem ucunda lateral femoral diyafizde oluşan 10 (%7.1) kırık için ek bir tedavi gereksinimi oluşmadı. Hiçbir olguda enfeksiyon, kayma ya da derin ven trombozu gözlenmedi.

Çıkarımlar: Femur boyun koruyucu protez ile total kalça artroplastisi değişik etiyolojileri olan genç hastalar için iyi bir seçenek olsa da, komplikasyonların engellenmesi için yakın takip şarttır.

Keywords

Artroplasti; femur boyun koruyucu protez; kalça eklemi; takip.

Analysis of the complications of the collum femoris preserving (CFP) prostheses

Abstract

Objective: The aim of this study was to evaluate the clinical and radiological outcomes and complications of total hip arthroplasty (THA) using the collum femoris preserving (CFP) prosthesis.

Methods: The study included the 142 hips of 125 patients (mean age: 50 years; range: 38 to 60 years) who underwent THA with CFP prosthesis between January 2004 and December 2011. There were 70 males (82 hips) and 55 females (60 hips). Patients were assessed using the Harris hip score (HHS) and visual analog scale (VAS). Radiographs were evaluated according to the Gruen zones and DeLee and Charnley zones to assess the prosthesis position, loosening and ectopic ossification.

Results: Follow-up was obtained over 4.72±2.16 (range: 1 to 8.4) years and no patients were lost to follow-up. Mean HHS improved from 51.43±4.14 points preoperatively to 90.27±6.60 points postoperatively, while VAS scores decreased from 8.3±3.12 to 2.1±1.54 by the final review. The HHS revealed excellent and good results in 87.4% of patients. Mild ectopic ossification occurred in 4 cases (2.8%), which were all Grade 1 according to the Brooker classification and without clinical symptoms. In 5 cases (3.5%), bone loss was found in the proximal femur. Radiolucent lines surrounding the stem were not observed in any case. There was no prosthesis loosening or femoral prosthesis subsidence. The survival rate was 100% for the femoral and acetabular components. Ten fractures (7%) of the lateral femoral diaphysis at the tip of the stem occurred during surgery and none of these required additional treatment. No infection, dislocation or deep vein thrombosis was observed.

Conclusion: Total hip arthroplasty with CFP prosthesis appears to be a good option for young patients for a variety of etiologies but close attention should be paid to the prevention of complications.

Keywords

Arthroplasty, collum femoris preserving prosthesis, follow-up, hip joint

References

• Molli RG, Lombardi AV Jr, Berend KR, Adams JB,
• Sneller MA. A short tapered stem reduces intraoperative
• complications in primary total hip arthroplasty. Clin Or
• thop Relat Res 2012;470:450-61. CrossRef 2. Lingard EA, Muthumayandi K, Holland JP. Comparison
• of patient-reported outcomes between hip resurfacing and
• total hip replacement. J Bone Joint Surg Br 2009;91:1550- 4. CrossRef 3. Killampalli VV, Kundra RK, Chaudhry F, Chowdhry M,
• Fisher NE, Reading AD. Resurfacing and uncemented ar
• throplasty for young hip arthritis: functional outcomes at
• 5 years. Hip Int 2009;19:234-8. 4. Goebel D, Schultz W. The Mayo cementless femoral
• component in active patients with osteoarthritis. Hip Int
• 2009;19:206-10. 5. Ghera S, Pavan L. The DePuy Proxima hip: a short stem
• for total hip arthroplasty. Early experience and technical
• considerations. Hip Int 2009;19:215-20. 6. Ettinger M, Ettinger P, Lerch M, Radtke K, Budde S, Eze
• chieli M, et al. The NANOS short stem in total hip ar
• throplasty: a mid term follow-up. Hip Int 2011;21:583-6. 7. Zeh A, Weise A, Vasarhelyi A, Bach AG, Wohlrab D.
• Medium-term results of the Mayo™ short-stem hip pros
• thesis after avascular necrosis of the femoral head. [Article
• in German] Z Orthop Unfall 2011;149:200-5. [Abstract] 8. Pipino F, Molfetta L. Femoral neck preservation in total
• hip replacement. Ital J Orthop Traumatol 1993;19:5-12. 9. Gruen TA, McNeice GM, Amstutz HC. “Modes of fail
• ure” of cemented stem-type femoral components: a ra
• diographic analysis of loosening. Clin Orthop Relat Res
• 1979;141:17-27. 10. DeLee JG, Charnley J. Radiological demarcation of ce
• mented sockets in total hip replacement. Clin Orthop
• Relat Res 1976;121:20-32. 11. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr.
• Ectopic ossification following total hip replacement. Inci
• dence and a method of classification. J Bone Joint Surg Am
• 1973;55:1629-32. 12. Pipino F, Calderale PM. Biodynamic total hip prosthesis.
• Ital J Orthop Traumatol 1987;13:289-97. 13. Pipino F, Molfetta L, Grandizio M. Preservation of the
• femoral neck in hip arthroplasty: results of a 13 to 17 year
• follow-up. J Orthop Traumatol 2000;1:31-9. CrossRef 14. Briem D, Schneider M, Bogner N, Botha N, Gebauer M,
• Gehrke T, et al. Mid-term results of 155 patients treated
• with a collum femoris preserving (CFP) short stem pros
• thesis. Int Orthop 2011;35:655-60. CrossRef 15. Kinov P, Radl R, Zacherl M, Leithner A, Windhager R.
• Correlation between thigh pain and radiological findings
• with a proximally porous-coated stem. Acta Orthop Belg
• 2007;73:618-24. 16. Davidson D, Pike J, Garbuz D, Duncan CP, Masri BA.
• Intraoperative periprosthetic fractures during total hip ar
• throplasty. Evaluation and management. J Bone Joint Surg
• Am 2008;90:2000-12. CrossRef 17. Jakubowitz E, Seeger JB, Lee C, Heisel C, Kretzer JP,
• Thomsen MN. Do short-stemmed-prostheses induce
• periprosthetic fractures earlier than standard hip stems? A
• biomechanical ex-vivo study of two different stem designs.
• Arch Orthop Trauma Surg 2009;129:849-55. CrossRef 18. Chen HH, Morrey BF, An KN, Luo ZP. Bone remodeling
• characteristics of a short-stemmed total hip replacement. J
• Arthroplasty 2009;24:945-50. CrossRef 19. Gillies RM, Kohan L, Cordingley R. Periprosthetic bone
• remodelling of a collum femoris preserving cementless ti
• tanium femoral hip replacement. Comput Methods Bio
• mech Biomed Engin 2007;10:97-102. CrossRef 20. Hayashi S, Nishiyama T, Fujishiro T, Kanzaki N, Hashi
• moto S, Kurosaka M. Periprosthetic bone mineral density
• with a cementless triple tapered stem is dependent on dai
• ly activity. Int Orthop 2012;36:1137-42. CrossRef 21. Rama KR, Vendittoli PA, Ganapathi M, Borgmann R,
• Roy A, Lavigne M. Heterotopic ossification after surface
• replacement arthroplasty and total hip arthroplasty: a ran
• domized study. J Arthroplasty 2009;24:256-62. CrossRef 22. Ritter MA, Galley M. Heterotopic bone formation follow
• ing resurfacing total hip arthroplasty. HSS J 2011;7:41-3.