ÇİMENTOSUZ TOTAL KALÇA ARTROPLASTİSİ: KISA VE ORTA DÖNEM SONUÇLAR

Öz

Amaç Eklem kıkırdağının yaş veya travmaya bağlı olarak zarar görmesine bağlı olarak hastanın hareketlerini kısıtlayıcı etki yapan koksartroz gelişebilmektedir. Koksartroz, kıkırdağın değiştirilmesi olan total kalça artroplasti ile tedavi edilmektedir. Bu çalışma ile, koksartrozlu hastalarda çimentosuz total kalça artroplastisinde (TKA) ameliyat sonrası sonuçlarla ilgili kısaorta dönem sonuçlarımız sunmak ve güncel literatür eşliğinde tartışmayı amaçladık. Gereç ve Yöntem Bu çalışmaya 1999 ve 2004 yılları arasında çimentosuz TKA tedavisi gören ve takibi yapılan, ortalama yaşı 54,1±9,6 olan 130 hasta (86 kadın, 44 erkek) dahil edilmiştir. TKA bağlı komplikasyonlar ve sonuçlar, hastaların takip dosyaları, laboratuvar testleri ve radyografilerine dayanarak gözden geçirilmiştir. Bulgular Preoperatif (41,75±9.62) ve post-operatif (90,44±7,51) modifiye Harris Kalça Skoru ölçümleri arasında istatistiksel olarak anlamlı fark bulunmuştur (p<0,001). On hastada (%7,6) ameliyat sırasında femur kırığı oluşmuştur. Anterior kalça ağrısı (26 hasta, %20,0) ve ekstremite boy farkı (20 hasta, %15,4) komplikasyonlar arasında en yaygınları olarak kaydedilmiştir. On üç hastada (%10,0) total kalça artroplastisi sonrası heterotrofik ossifikasyon gözlemlenmiş, ancak buna bağlı hareket kaybı gerçekleşmemiştir. Malpozisyon (7 hasta, %5,4), çıkık (3 hasta, %2,3), enfeksiyon (2 hasta, %1,5) ve derin venöz trombozu (1 hasta, %0,8) gözlemlenen diğer komplikasyonlar olmuştur. Asetabular komponentte gevşeme / migrasyon veya kalça hareketini kısıtlayan ağrı takip süresinde hiçbir hastada gözlenmemiştir. Sonuç Koksartrozlu hastalarda çimentosuz TKA ile kalça fonksiyonlarında düzelme elde edilmektedir. Bu yöntem ile tedavi edilecek koksartroz hastalarında, hastanın operasyon sonuçlarından memnun kalması, komplikasyonların en aza indirilmesi ve protezin uzun süre dayanması için detaylı bir ameliyat öncesi risk değerlendirmesinin yapılması gerekmektedir.

Anahtar Kelimeler

• Koksartroz
• artroplasti
• total kalça protezi

CEMENTLESS TOTAL HIP ARTHROPLASTY: SHORT AND MID-TERM RESULTS

Öz

Objective The destruction of the joint cartilage either by age or trauma can develop coxarthrosis limiting the motion of the patient, which is treated by the replacement of the whole joint with total hip arthroplasty. In this study, we aimed to report our short and mid-term results and discuss with the current literature on postoperative results of cementless total hip arthroplasty (THA) in patients with coxarthrosis. Material and Method One hundred thirty patients (86 female, 44 male) with a mean age of 54.1±9.6 years who underwent total hip arthroplasty with a cementless prosthesis included in the study. The outcomes and complications of the total hip arthroplasty were reviewed from patient’s counseling charts, laboratory tests and radiographs. retro Results There was a statistically significant difference between pre (41.75±9.62) and postoperative (90.44±7.51) mean modified Harris Hip Score measurements (p<0.001) indicating the successful outcome. Intraoperative femur fracture occurred in 10 patients (7.6%). Anterior thigh pain (26 patients, 20.0%) and extremity length difference (20 patients, 15.4%) were the most common complications observed. Although 13 patients (10.0%) had heterotopic ossification after total hip arthroplasty, none of the patients had limited motion associated with it. Malpositioning (7 patients, 5.4%), dislocation (3 patients, 2.3%), infection (2 patients, 1.5%) and deep venous thrombosis (1 patient, 0.8%) were among the other complications observed. There were no cases with acetabular cup migration or pain limiting hip movement. Conclusion The cementless THA provides improvement of hip function in patients with coxarthrosis. The preoperative risk assessment of the coxarthrosis patients is necessary to ensure patient’s satisfaction, minimize complications and provide long-term durability of the prosthesis.

Anahtar Kelimeler

• Coxarthrosis
• arthroplasty
• total hip prosthesis

Kaynakça

1. Referans1. Gasbarra E, Perrone FL, Celi M, Rao C, Feola M, Cuozzo N, Tarantino U. Total hip arthroplasty revision in elderly patients. Aging Clin Exp Res 2013;25 Suppl 1:61-63.
2. Referans2. Ateschrang A, Weise K, Weller S, Stöckle U, de Zwart P, Ochs BG. Long-term results using the straight tapered femoral cementless hip stem in total hip arthroplasty: a minimum of twenty-year follow-up. J Arthroplasty 2014; 29:1559-1565.
3. Referans3. Lehil MS, Bozic KJ. Trends in total hip arthroplasty implant utilization in the United States. J Arthroplasty 2014; 29:1915-18.
4. Referans4. Forster-Horvath C, Egloff C, Valderrabano V, Nowakowski AM. The painful primary hip replacement - review of the literature. Swiss Med Wkly 2014;144: w13974.
5. Referans5. Patel RM, Stulberg SD. The rationale for short uncemented stems in total hip arthroplasty. Orthop Clin North Am 2014; 45:19-31.
6. Referans6. Pelt CE, Madsen W, Erickson JA, Gililland JM, Anderson MB, Peters CL. Revision total hip arthroplasty with a modular cementless femoral stem. J Arthroplasty 2014;29:1803-07.
7. Referans7. Shi X, Zhou Z, Yang J, Shen B, Kang P, Pei F. Total hip arthroplasty using non-modular cementless long-stem distal fixation for salvage of failed internal fixation of intertrochanteric fracture. J Arthroplasty 2015; 30:1999-2003.
8. Referans8. Adelani MA, Keeney JA, Palisch A, Fowler SA, Clohisy JC. Has total hip arthroplasty in patients 30 years or younger improved? A systematic review. Clin Orthop Relat Res 2013; 471:2595-2601.

9. Referans9. Schaller G, Black J, Asaad A, Harper N, Webb S, Muirhead-Allwood S. Primary collared uncemented total hip arthroplasties in the elderly: a safe and reliable treatment option. J Arthroplasty 2015; 30:407-10.
10. Referans10. Taheriazam A, Saeidinia A. Cementless one-stage bilateral total hip arthroplasty in osteoarthritis patients: Functional outcomes and complications. Orthop Rev (Pavia) 2017; 9:68-97.
11. Referans11. Innmann MM, Spier K, Streit MR, Aldinger PR, Bruckner T, Gotterbarm T, Merle C. Comparative analysis of the reconstruction of individual hip anatomy using 3 different cementless stem designs in patients with primary hip osteoarthritis. J Arthroplasty 2018; 33:1126-32.
12. Referans12. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg Am 1969:51:737-755.
13. Referans13. Singh M, Nagrath AR, Maini PS. Changes in trabecular pattern of the upper end of femur as an index of osteoporosis. J Bone Joint Surg 1970; 52:457-67.
14. Referans14. Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. 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; 67:1074-85.
15. Referans15. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976; 121:20-32.
16. Referans16. 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.
17. Referans17. Vancouver classification. (Duncan CP, Masri BA. Fractures of the femur after hip replacement. Instr Course Lect. 1995; 44:293–304.
18. Referans18. Brooker AF, Bowerman JW, Robinson RA, Riley LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973; 55:1629-1632.
19. Referans19. Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J. 2015 ;97-B (8):1076-81.
20. Referans20. Lavernia C, D'apuzzo M, Hernandez VH, Lee DJ. Patient-perceived outcomes in thigh pain after primary arthroplasty of the hip. Clin Orthop Relat Res. 2005 Dec; 441:268-73
21. Referans21. Callaghan JJ, Dysart SH, Savory CG: The uncemented porous- coated anatomic total hip prosthesis: Two-year results of a prospective consecutive series. J Bone Joint Surg 70A:337–46, 1988
22. Referans22. Jo WL, Lee YK, Ha YC, Park MS, Lyu SH, Koo KH. Frequency, developing time, intensity, duration, and functional score of thigh pain after cementless total hip arthroplasty. J Arthroplasty 2016; 31:1279-82.
23. Referans23. Baert IAC, Lluch E, Van Glabbeek F, Nuyts R, Rufai S, Tuynman J, Struyf F, Meeus M. Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain. Med Hypotheses. 2017 Sep; 107:45-50
24. Referans24. Amendola RL, Goetz DD, Liu SS, Callaghan JJ. Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern. Clin OrthopRelat Res. 2017;475(2):375-383.
25. Referans25. Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int 2014; 111:884-90.
26. Referans26. Ponzio DY, Shahi A1, Park AG1, Purtill JJ. Intraoperative proximal femoral fracture in primary cementless total hip arthroplasty. J Arthroplasty 2015; 30:1418-22.
27. Referans27. Bonnin MP, Neto CC, Aitsiselmi T, Murphy CG, Bossard N, Roche S. Increased incidence of femoral fractures in small femurs and women undergoing uncemented total hip arthroplasty - why? Bone Joint J 2015;97-B:741-8.
28. Referans28. Berend KR, Lombardi AV Jr. Intraoperative femur fracture is associated with stem and instrument design in primary total hip arthroplasty. Clin Orthop Relat Res. 2010 Sep;468(9):2377-81
29. Referans29. Graf R, Azizbaig-MohajerM. Minimally invasive total hip replacement with the patient in the supine position and the contralateral leg elevated. Oper Orthop Traumatol. 2006;18:317-29.
30. Referans30. Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ. Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA. Clin Orthop Relat Res. 2015 Jun;473(6):2131-8.
31. Referans31. Prudhon JL, Steffann F, Ferreira A, Verdier R, Aslanian T, Caton J. Cementless dual-mobility cup in total hip arthroplasty revision. Int Orthop 2014; 38:2463-8.
32. Referans32. Sculco PK, Cottino U, Abdel MP, Sierra RJ. Avoiding Hip Instability and Limb Length Discrepancy After Total Hip Arthroplasty. Orthop Clin North Am. 2016 Apr;47(2):327-34).
33. Referans33. Zhu Y, Zhang F, Chen W, Zhang Q, Liu S, Zhang Y. Incidence and risk factors for heterotopic ossification after total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2015; 135:1307-14.
34. Referans34. Tippets DM, Zaryanov AV, Burke WV, Patel PD, Suarez JC, Ely EE, Figueroa NM. Incidence of heterotopic ossification in direct anterior total hip arthroplasty: a retrospective radiographic review. J Arthroplasty 2014; 29:1835-8.
35. Referans35. Merollini KM, Crawford RW, Whitehouse SL, Graves N. Surgical site infection prevention following total hip arthroplasty in Australia: a cost-effectiveness analysis. Am J Infect Control 2013; 41:803-9.
36. Referans36. Konigsberg BS, Della Valle CJ, Ting NT, Qiu F, Sporer SM. Acute hematogenous infection following total hip and knee arthroplasty. J Arthroplasty 2014; 29:469-72.
37. Referans37. Fujita S, Hirota S, Oda T, Kato Y, Tsukamoto Y, Fuji T. Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan. Clin Orthop Relat Res 2000; 375:168-74.
38. Referans38. Suzuki H, Matsuzawa Y, Konishi M, Akiyama E, Takano K, Nakayama N, et al. Utility of noninvasive endothelial function test for prediction of deep vein thrombosis after total hip or knee arthroplasty. Circ J 2014; 78:1723-32