Randomised clinical trial assessing migration of uncemented primary total hip replacement stems, with and without autologous impaction bone grafting.

Autor: Rutherford M; Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia. michael.rutherford1@my.nd.edu.au.; The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia. michael.rutherford1@my.nd.edu.au., Khan RJK; Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia.; The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia.; School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, 6160, Australia., Fick DP; Hollywood Private Hospital, Monash Avenue, Perth, WA, 6009, Australia.; The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia., Haebich S; The Joint Studio, Suite 1/85 Monash Avenue, Perth, WA, 6009, Australia., Nivbrant O; Department of Orthopaedics, Umeå University, Umeå, Sweden., Kozak T; Royal Perth Hospital, 197 Wellington St., Perth, WA, 6000, Australia.
Jazyk: angličtina
Zdroj: International orthopaedics [Int Orthop] 2019 Dec; Vol. 43 (12), pp. 2715-2723. Date of Electronic Publication: 2019 Jan 31.
DOI: 10.1007/s00264-019-04290-5
Abstrakt: Purpose: Uncemented stems in primary total hip replacement (THR) are concerning in the elderly due to ectatic femoral canals and cortical thinning resulting in higher incidence of fracture and subsidence in this population. To obviate this concern, the authors developed a technique using autologous impaction bone grafting to achieve a better fitting femoral stem. The aim of this randomised clinical trial was to assess the efficacy of the technique.
Methods: From 2013 to 2015, a total of 98 consecutive participants (100 primary THR procedures) were inducted into a single-institution, single-blinded, randomised clinical trial assessing, with radiostereometric analysis (RSA), the efficacy of autologous impaction bone grafting in uncemented primary THR compared with traditional uncemented primary THR technique. The primary outcome measure was femoral component migration using RSA. Secondary outcomes were post-operative proximal femoral bone density (using DEXA), hip function and quality of life using Oxford Hip Score (OHS) and Short Form-12 Health Survey (SF-12), hip pain and patient satisfaction.
Results: There was no difference in femoral component stability (p > 0.5) or calcar resorption between the Graft and No Graft Groups at two years. There was also no difference in OHS, SF-12, pain or satisfaction between the Graft and No Graft Groups at two years (p > 0.39).
Conclusions: Autologous impaction bone grafting in uncemented primary THR has shown its short-term post-operative outcomes to be equivalent to standard uncemented technique, whilst offering a better fit in patients who are between femoral stem sizes.
Australian Clinical Trial Registration Number: ACTRN12618000652279.
Databáze: MEDLINE
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