| BackgroundArtificial total hip replacement is the preferred method for the treatment of advanced femoral head necrosis lesions. The number of cases of loosening of artificial joint prosthesis needing revision surgery increases with increasing clinical application of artificial hip joint prosthesis. Stemless hip replacement is increasingly introduced in clinic because of some of its advantages. First, it retains all of the femoral neck, and maintains cervicofemoral angle (CA) and femoral neck anteversion (FNA) of itself, which make it much closer to human body biomechanics. Second, reaming of the femoral canal do not need to be employed during operations and postoperative complications conveniently reduces. Furthermore, In the present work, a comprehensive comparison for the clinical effect using the stemless and stem hip replacement to treate femoral head necrosis was performed, respectively. The clinical effect with stemless hip replacement to treat femoral head necrosis was observed.ObjectiveClinical materials of 98 patients with stemless hip replacement to treat femoral head necrosis were retrospectively analyzed. The aim of this retrospective study is to compare clinical efficacy of using the stemless or stem hip replacement, and to investigate the clinical efficacy of stemless hip replacement for femoral head necrosis.MethodClinical materials of 98 patients with stemless hip replacement to treat femoral head necrosis in PLA 371 Hospital between 2011.9 and 2014.10 were retrospectively analyzed. The aim of this retrospective study is to compare clinical efficacy of using the stemless or stem hip replacement, and to investigate the clinical efficacy of stemless hip replacement for femoral head necrosis.50 patients aged 21 to 66, and with an average age of 55.6 were selected with stemless prosthesis, including 43 male patients,7 female patients.52 total hip arthroplasties with an average of 5.2 years of medical history (from 0.5 to 26.0 years of medical history) were performed including 2 full hip substitution,48 half hip substitution. 48 patients aged 24 to 71, and with an average age of 56.2 were selected with stem prosthesis, including 38 male patients,10 female patients.48 total hip arthroplasties with an average of 6.3 years of medical history (from 1.2 to 27.0 years of medical history) were performed. The two groups mentioned above were managed by the same medical team, and all operations were conducted smoothly by the same surgeon. The contraindication should to be excluded before the operation. Careful medical examination was performed with X-ray and MRI in all patients before surgery. SCT scan imaging studies should to be used to account for bone defect in order to exclude some diseases, such as the active infection of joint, tuberculosis, bone tumor, etc. Preoperative Harris score was given. Postoperative follow patients were made in order to gain a better understanding of the pain of patients, double lower limbs are equal or not, the operative incision healing, the range of motion of hip joint, and so on. And then, the postoperative Harris score was given according to the follow-up results. In addition, patients were followed should to be examined by X-ray to know some relevant information about the shape of the hip joint, the position of the acetabular and femoral prosthesis, the congruence between the prosthesis and the acetabulum, the change of the bone length and the stability of the prosthesis, etc.ResultThe preoperative Harris score with stemless prosthesis averaged 58.16. The average is 76.24,82.23,91.12,93.45, and 95.67 at 3 months,6 months,12 months,24 months, and 36 months postoperatively, respectively. The preoperative Harris score with stem prosthesis averaged 60.22. The average is 77.24,83.68,92.69,93.41, and 94.62 at 3 months,6 months,12 months,24 months, and 36 months postoperatively, respectively. There are no significant differences between the two groups mentioned above in operation time, all hospitalization time, postoperative hospitalization time, and postoperative Harris score, but there are significant differences in the amount of bleeding during operation (P<0.05). The postoperative Harris scores of the two grounds mentioned above are both reached the good grade. Significant differences are observed about Harris scores before and after the operation for the same ground (P<0.05). Nevertheless, there are no significant differences about Harris scores at 12 months postoperatively.X-ray examination shows that all of the acetabular components are in good position of 50 patients (52 hips) with stemless prosthesis. The average of acetabular anteversion angle is 17.3° (from 10.2° to 20.5°), and the average of acetabular abduction angle is 42.6° (from 38.7° to 46.1°). X-ray examination shows that all of the acetabular components are in good position of 48 patients (48 hips) with stem prosthesis. The average of acetabular anteversion angle is 18.9° (from 12.8° to 21.6°), and the average of acetabular abduction angle is 43.7° (from 39.2° to 47.2°). The cener of the periprosthetic femoral is fixation and with good location. The follow-up has not discovered the prosthesis loosening. For the ground with stemless prosthesis,1 case of incisive infection (2.00%),3 cases (6.00%) with the pain around hip. For the ground with stem prosthesis,2 case of deep vein thrombosis (4.16%),4 cases (8.33%) with the pain around hip.ConclusionThe clinic effect of the stemless prosthesis is close to the stem prosthesis for the femoral head necrosis treated with hip replacement. Postoperative complications were few,clinical curative effect is satisfactory. |
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