Femur boyun koruyucu (FBK) protezlerin yol açtığı komplikasyonların analizi

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

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