人工骨頭置換術後の長期成績　　大腿骨頚部骨折に対するセメントレス人工骨頭置換術の成績

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  • Results of Cementless Bipolar Hip Prostheses in Patients with Femoral Neck Fracture

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We performed a retrospective study of the clinical and radiological outcomes of cementless bipolar hip prostheses in patients with femoral neck fracture.<BR>Out of 157 patients who underwent a primary hemiarthroplasty between January 1987 and December 1998, 24 patients (26 procedures) were available for follow-up evaluation. Three Harris/Galante porous prostheses, 10 Multilock prostheses, 7 Multilock-HA prostheses (Zimmer) and 6 PHS prostheses (Kyoto ceramic) were implanted in these patients. The mean patient age at the time of the procedure was 67.4 years (49 to 90 years), and the mean follow-up period was 7.2 years (3 to 13 years) .<BR>At the time of the final follow-up examination, the mean Japan Orthopaedic Association score was 68.8. All of the patients could walk without using the support of a cane, crutches or a walker. Eight patients (30.8%) complained of thigh pain. Radiologically, the canal filled rate around the stem had decreased in all of the prostheses. Spot welds were seen in 2 hips (33.3%) with PHS prostheses, 2 hips (66.7%) with Harris/Galante prostheses, 7 hips (70%) with Multilock prostheses, and 5 hips (71.4%) with Multilock-HA prostheses. Pedestal formation was seen in 5 hips (47.8%) with PHS prostheses, 6 hips (60%) with Multilock prostheses and 5 hips (71.4%) with Multilock-HA prostheses. Stem sinking was seen in 5 hips (83.3%) with PHS prostheses and 1 hip (33.3%) with a Harris/Galante prosthesis. Stem loosening was seen in 4 hips (66.7%) with PHS prostheses and 1 hip (33.3%) with a Harris/ Galante prosthesis. Central migration was seen in 1 hip (16.6%) with a PHS prosthesis and 1 hip (10%) with a Multilock prosthesis.<BR>We conclude that non-porous stem prostheses do not provide adequate initial stability, and that porous-coated stem prostheses are satisfactory for use in patients with femoral neck fractures. Further study is necessary to determine the long-term durability of these prostheses.

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