- 期刊
Cementless Bipolar Endoprosthesis in The Treatment of Avascular Necrosis of The Femoral Head
並列摘要
Between November 1983 and January 1990, 88 hips in 70 patients (61 men, 9 women) with non-traumatic avascular necrosis of the femoral head (ANFH) were performed with cementless bipolar hemiarthroplasy at the authors’ hospital. There two types of stem fixation: macrolocking (Giliberty, mecron, 29 hips) and microlocking / bone ingrowth (Roy Camille, PCA, Osteonice, 59 hips) in this series. Patients were divided into two groups according to the different implantation of the femoral stem. Clinical and radiographic results were evaluated and compared. The average age at operation was 39.9 years (range, 22-59) and the mean follow-up period was 6.9 years (range, 5-12). Hip scores using the Merle D’Aubigne and Postel system (18 points for a normal hip) were improved from 11.4 to 16.8 at the latest follow up. Satisfactory results (a score of 15 or greater) were maintained through the follow-up period in most of the cases (80%, 70 out of 88). The results in the microlocking group was better than the macrolocking group (86.4% vs 65.5%). In most cases, the cartilaginous spaces of the acetabulum were preserved after more than 6 years. Only one hip had severe acetabular protrusion. The stem loosening rate of the microlocking group was significantly lower than the macrolocking group (5.1% v.s. 34.5%). Only 5 cases (5.7%) received revision THR. All the cases were in the macrolocking group Porous-coated Femoral stem provides more stable fixation due to bone ingrowth and higher canal-filling ratio (93% v.s. 72%). The incidence of femoral osteolysis was 13.6% (microlocking 10%, macrolocking 20.1%). Moreover, the major discomfort complained by the patients was thigh pain (microlocking 6.7%, macrolocking 34.5%) and groin pain (microlocking 11.8%, macrolocking 13.8%). We concluded that the cementless bipolar hemiarthroplasty using bone ingrowth stem was still feasible for the young active patients with early stage of ANFH (Ficat stage 3). Moreover, thigh pain, groin pain and femoral osteolysis are still problems needed to be resolved by further improvement of the bipolar endoprostesis design.
延伸閱讀
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