Koksartrozda uygulanan çimentosuz total kalça protezinin klinik sonuçları

Yıl 2020, Cilt: 45 Sayı: 2, 731 - 737, 30.06.2020

Melih Bağır , Ahmet Yılmaz

https://doi.org/10.17826/cumj.686836

Öz

Amaç: Total kalça protezi uygulamalarında çimentolu, çimentosuz ve hibrid tespit yöntemlerinin sonuçları tartışılmaya devam etmektedir. Çalışmamızın amacı, çimentosuz total kalça protezi olgularımızın klinik ve radyolojik sonuçlarını literatür eşliğinde değerlendirmektir.
Gereç ve Yöntem: Çalışmamızda çimentosuz total kalça protezi uygulanan olgular geriye dönük olarak değerlendirildi. En az 1 yıllık takibi olan 80 hastanın 95 kalçası çalışmaya dahil edildi. Klinik değerlendirmede Harris kalça skoru (HKS) kullanıldı. Radyolojik değerlendirmede ise komponentlerin malpozisyonuna ve gevşemeye bakıldı. Ayrıca hastalar heterotopik ossifikasyon, dislokasyon ve diğer komplikasyonlar açısından incelendi.
Bulgular: Hastaların 47 (%58.7)’si kadın, 33 (%41.3)’ü erkekti. Olguların yaş ortalaması 52.312.8 idi. Otuz altı (%45) hastada sağ kalça, 29 (%36) hastada sol kalça ve 15 (%18.7) hastada bilateral kalça protezi uygulandı. Cerrahi yaklaşım olarak, hastaların 74 (%77.9)’ünde posterolateral, 21 (%22.1)’inde anterolateral insizyon kullanıldı. Ortalama takip süresi 3818.8 ay idi. Hastaların ameliyat öncesi ve son kontroldeki toplam Harris kalça skorları sırasıyla 28.5210.93 ve 87.097.03 idi. Radyolojik değerlendirmede hastaların 12 (%12.6)’sinde asetabuler malpozisyon tespit edildi. Hastaların 8 (%8.4)’inde intraoperatif kırık saptandı.
Sonuç: Çimentosuz total kalça protezi uyguladığımız hastalarımızda, kısa ve orta dönemde Harris kalça skoru değerlendirmesine göre başarılı klinik sonuçlar elde edilmiştir. Çimentosuz tespitte erken dönemde sıkı stabilizasyon sağlanır, fakat intraoperatif kırık ve asetabuler komponentlerin malpozisyonu açısından dikkatli olunmalıdır.

Anahtar Kelimeler

Osteoartrit, kalça, artroplasti

Clinical outcomes of cementless total hip replacement in coxarthrosis

Öz

Purpose: The outcomes of cemented, cementless and hybrid fixation options in total hip replacement are still controversial. The aim of our study is to evaluate the clinical and radiological results of our cementless total hip replacement cases compared with the literature.
Materials and Methods: We evaluated 80 patients’ 95 cementless total hip arthroplasties retrospectively. The minmum follow up periodwas 12 months. We used the Harris Hip Score (HHS) for clinical evaluation. We evaluated malposition, aseptic loosening, heterotopic ossification, dislocation and other complications by direct radiography.
Results: Forty seven (58.7%) of the patients were female and 33 were male (41.3%). Mean age of the patients was 52.312.8 years. Thirtysix (45%) of the patients were operated in the right hip, 29 (36%) of the patients were operated in the left hip and 15 (18.7%) of the patients were operated bilaterally. Posterolateral incision was used in 74 (77.9%) patients and posterolateral incision was used in 21 (22.1%) patients. Mean follow up was 3818.8 months. Total Harris hip scores of the patients before and after surgery were 28.5210.93 and 87.097.03, respectively. There was acetabular malposition in 12 patients. Eight patients had intraoperative fractures.
Conclusion: Cementless total hip arthroplasty provided good clinical outcomes in Harris Hip Score evaluation in short to-medium-term. Rigid cementless fixation in early period can be achieved but, caution is advised against intraoperative fracture and acetabular component malposition.

Kaynakça

• Tuna H. Kalça osteoartriti. Osteoartrit ( Ed M Sarıdoğan M) : 143-145. İstanbul, Nobel Tıp Kitapevleri, 2007.
• Johnston RC, Fitzgeralg RH, Harris WH, et al. Clinical and radiologic evaluation of total hip replacement. J Bone Joint Surg (Am). 1990;72:161-68.
• McAuley JP, Moore KD, Engh CA. Total hiparthroplasty with porous-coated prostheses fixed without cement in patients who are sixty five years of age or older. J Bone. Joint Surg (Am). 1998;80:1648-55.
• Wroblewski BM, Flemin PA, Siney PD. Charnley. Low-frictionalt or quearthroplasty of hip. J Bone Joint Surg. 1999;81B:427-30.
• Clohisy JC, Harris WH. Matched-pair analysis of cemented and cementlees acetabular reconstruction in primary total hip arthroplasty. J Arthroplasty. 2001;16:697-705.
• Laupacis A, Bourne R, Rorabeck C, et al. Comparasion of total hip arthroplasty performed with and without cement. J Bone Joint Surg. 2002;84A: 1823-1828.
• Harris WH. Total hip replacement in the middle aged patient. Contemporary cementing for fixation of the femoral component. Orthop Clin North Am. 1993;24:611-615.
• Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17-27.
• DeLee JG, Channley J. Radiologicaldemarcation of cementedsockets in total hipreplacement. ClinOrthopRelatRes. 1976;121:20-32.
• Brooker AF, Bowerman JW, Robinson RA, Riley LHJ. Ectopic ossification following total hip replacement. Incidenceand a method of classification. J Bone Joint Surg Am. 1973;55(8):1629–32.
• Sinha RK, Dungy DS, Yeon HB. Primary total hiparthroplasty with a proximally porous-coated femoral stem. J Bone Joint Surg. 2004;86(6):1254-61.
• Meding JB, Keating EM, Ritter MA. Minimum ten-year follow-up of a straight-stemmed, plasma-sprayed, titanium-alloy, uncemented femoral component in primary total hip arthroplasty. J Bone Joint Surg. 2004;86(6): 92-97.
• Lachiewicz PF, Soileas ES, BryantP. Second-generation proximally coated titanium femoral component: minimum 7-year results. Clin Orthop Relat Res.2007;465:117-121.
• Martell JP, Pierson RH, Jacob JJ. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg. 1993;75:554-574.
• Schwartz JT, Mayer JG, Engh CA. Femoral fracture during non-cemented total hip arthroplasty. J Bone Joint Surg.1989;71A:1135-1142.
• Bourne RB, Roraback CH, Patterson JJ. Tapered titanium cementless total hip replacements: a 10- to 13-year followup study. Clin Orthop Relat Res. 2001;393:112-120.
• Berry DJ. Epidemiology hip and knee. Orthop Clin North Am. 1999;30,2:183-190.
• Scifert CF, Brown TD, Pedersen DR. A finite element analysis of factors influencing total hip dislocation. 1988;355:152-162.
• D’Lima DD, Urquhart AG, Buehler KO, et. Al. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg. 2000;17:359-364.
• Eggli S, Woo A. Risc factors for heterotopic ossification in total hip arthroplasty. Arch OrthopTrauma Surg. 2001;121:531-535.
• Purtill JJ, Eng K, Rothman RH, et al. Heterotopic ossification incidence in cemented versus cementless total hip arthroplasty. J Arthroplasty. 1996;11:58-63.
• Birschoff R, Von Knoch M, Schleck CD, et al. Heterotopic ossification following uncement total hip arthroplasty: effect of the operative approach. J Arthroplasty. 1994;9:641-644.
• Foster DE, Hunter JR. The direct lateral approach to the hip for arthroplasty: advantages and complications. Orthopedics. 1987;10:274-280.
• Morrey BF, Adans RA, Cabanela ME. Comparation of heterotopic bone after anterolateral, transtrochanteric and posterior approaches for total hip arthroplasty. Orthop Relat Res. 1984;188:160-167.
• Woo RY, Morrey BF. Dislocationafter total hiparthroplasty. J Bone JointSurg(Am). 1982;64:1295-1306.
• Edwards PD, TullosHS, Noble PC. Contrybutory factors and etiology of sciatic nerve palsy in total hip arthroplasty. Clin Orthop. 1987;218:136-141.
• Fitzgerald RH. Total hip arthroplasty sepsis, prevention and diagnosis. Orthop Clin North Am. 1992;23:249-264.