Abstract
A comparative analysis of the clinical, functional and radiological results of total hip arthroplasty (THA) in pts with primary osteoarthritis (PA) was carried out. The aim was to improve the results of THA in pts with degenerative diseases of the hip joint based on the choice of the optimal type of components fixation. The study included 125 patients (68 women, 57 men) with primary coxarthritis who underwent 125 operations of unilateral THA. All pts were divided into two groups depending on the type of components fixation. Group I (N = 63; average age 69.8 ± 3.1; from 34 to 75 years) included pts with cementless fixation (DePuy, Zimmer, titanium cups, titanium stems such as Corail and Zweymuller), in group II (N = 62; average age 67.2 ± 2.7; from 44 to 87 years) — with cement fixation (Zimmer, Smith & Nephew — low-profile Muller cup, Muller stem). Metal-polyethylene friction pair and head size 32 mm were used in all cases. Evaluation of the results was carried out on 2, 6 months, 1, 5, 10 years after the operation and included: functional state assessment (Harris Hip Score), radiographs analysis, as well as the frequency of complications and revision interventions. There were no significant differences in the incidence of deep periprosthetic infection, thromboembolic complications, hematomas, paraarticular ossifications, aseptic loosening, dislocations and revision interventions. There was faster positive dynamics in the early period (up to 6 months) when using cemented THA. Subsequently all the indicators were comparable in both groups. Osteolysis at the border of implant fixation was recorded in two cases in group I and in 11 cases in group II (p < 0,05). In group I, eight periprosthetic intraoperative fractures of the proximal hip were recorded; in group II, this complication was obtained in one pt (p < 0.05). Stress-shielding syndrome was detected in six pts from group I. This complication was not detected in group II (p < 0.05). Thus, both methods are comparable in results and can be equally applicable for the surgical treatment of patients with primary osteoarthritis, which can significantly expand the possibilities of specialized medical care and effective rehabilitation of this category of patients.
Highlights
There were no significant differences in the incidence of deep periprosthetic infection, thromboembolic complications, hematomas, paraarticular ossifications, aseptic loosening, dislocations and revision interventions
Серия «Ревматология в общей врачебной практике». — 2019. — Т. 2. — 37 (412). — С. 34–39
Summary
125 пациентов (68 женщин, 57 мужчин) с первичным ОА, которым было выполнено 125 операций первичного тотального одностороннего эндопротезирования. В зависимости от типа фиксации компонентов пациенты были распределены на две группы. В I группу (N = 63; средний возраст 69,8 ± 3,1 года; от 34 до 75 лет) были включены пациенты с бесцементной фиксацией эндопротеза (De Puy, Zimmer, титановые чашки, титановые ножки типа Corail и Zweymuller), во II группу (N = 62; средний возраст 67,2 ± 2,7 года; от 44 до 87 лет) — с цементной фиксацией (Zimmer, Smith & Nephew — низкопрофильная чашка Muller, ножка Muller), во всех случаях применялась пара трения «металл — полиэтилен», размер головки — 3 2 мм. Распределение пациентов по возрасту и полу в сравниваемых группах представлено в табл. Критериями исключения из исследования являлись: наличие в анамнезе хирургических вмешательств на тазобедренном суставе; посттравматические и инфекционные артриты; наличие сопутствующей патологии, значительно ограничивающей функциональное состояние пациента; опухоли области тазобедренного сустава; выраженная костная деструкция, требующая дополнительной реконструкции (костной пластики, замещения дефектов титановыми трансплантатами и т. д.); системные заболевания соединительной ткани
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