ObjectiveTo evaluate the mid- and long-term effectiveness of total hip arthroplasty (THA) with Ribbed femoral stem prosthesis.MethodsA clinical data of 354 patients (384 hips) with hip disease who underwent THA with Ribbed femoral stem prostheses between October 2006 and May 2016 was retrospectively analyzed. There were 171 males and 183 females, with an average age of 53.4 years (range, 20-82 years). There were 324 cases of single hip and 30 cases of bilateral hips. The cause of THA included the avascular necrosis of the femoral head in 151 cases (159 hips), hip osteoarthritis in 134 cases (136 hips), rheumatoid arthritis in 43 cases (43 hips), ankylosing spondylitis in 20 cases (40 hips), and trauma in 6 cases (6 hips). The Harris score of total 354 patients before operation was 42.34±8.89. Harris scores were used to evaluate hip function after operation. X-ray films were used to determine the length of the lower limb, the radiolucent line on the femur side, the stability of the prosthesis, and the occurrence of stress shielding.ResultsThe incisions healed by first intention. All patients were followed up 2-11 years with an average of 7.4 years. The Harris score at last follow-up was 80.52±7.61, which significantly increased when compared with preoperative score (t=134.804, P=0.000). Two cases (2 hips) of prosthetic infections, 3 cases (3 hips) of prothesis loosening, and 4 cases (4 hips) of periprosthetic fractures, and 48 cases (48 hips) of mild to moderate thigh pain occurred after operation. X-ray films showed 76 cases (78 hips) with radiolucent lines on the femur side and stress shielding. According to the Engh’s method, there were 364 hips of bone ingrowth, 15 hips of fibrosis ingrowth, and 5 hips of prosthesis instability. The femoral stem subsidence occurred in 25 cases (25 hips), and the difference in leg length discrepancy was more than 10 mm in 5 patients.ConclusionTHA with Ribbed femoral stem prosthesis can achieve satisfactory effectiveness with good initial stability and rapid bone growth. The incidence of stress shielding is relatively high, but the stress shielding has no significant impact on the mid- and long-term survival rate and effectiveness of femoral prosthesis.
Objective To investigate the short- and mid-term effectiveness and prosthesis survival rate in patients undergoing total knee arthroplasty (TKA) using domestic cementless knee prostheses with three-dimensional (3D)-printed trabecular metal interface. Methods A retrospective analysis was performed on the clinical data of 79 patients who underwent primary TKA for end-stage knee disorders, met the selection criteria and were treated between December 2021 and March 2022. There were 39 patients in the cementless group receiving cementless knee prostheses with 3D-printed trabecular metal interface, and 40 patients in the cemented group adopting posterior-stabilized cement-fixed knee prostheses. Baseline data including age, gender, body weight, disease type, disease duration, and preoperative Knee Society Score (KSS) (clinical score and function score) showed no significant differences between the two groups (P>0.05). Operation time, intraoperative blood loss, and complications were recorded and compared between groups. KSS clinical and function scores before operation and at last follow-up were used to evaluate knee functional recovery. Radiographic assessment was conducted to detect prosthesis loosening, osteolysis, prosthesis subsidence, joint dislocation, and other abnormalities. Prosthesis survival rate was calculated with complete or partial prosthesis removal defined as the endpoint event, and Kaplan-Meier method was adopted to plot prosthesis survival curves. Results All patients successfully completed surgery. No significant intergroup differences were found in operation time and intraoperative blood loss (P>0.05). All patients in the cementless group and cemented group were followed up for (28.4±2.4) months and (28.2±2.8) months respectively, without significant difference (t=?0.274, P=0.785). At last follow-up, both KSS clinical and function scores were significantly higher than preoperative values in both groups (P<0.05), while no significant intergroup differences were observed in the changes of each score (P>0.05). X-ray films at last follow-up revealed no prosthesis loosening, osteolysis, prosthesis subsidence, or joint dislocation in any patient. During follow-up, 5 cases of intermuscular venous thrombosis occurred in the cementless group; in the cemented group, there were 6 cases of intermuscular venous thrombosis, 1 case of poor wound healing, 1 case of periprosthetic joint infection, 1 case of periprosthetic fracture, and 1 case of all-cause death. The complication rates of the two groups (12.8% vs 25.0%) were not different (P>0.05). One revision surgery was performed for periprosthetic joint infection and 1 for periprosthetic fracture in the cemented group, corresponding to a prosthesis survival rate of 95.0%; no endpoint events occurred in the cementless group, with a prosthesis survival rate of 100.0%. Kaplan-Meier survival curve analysis demonstrated no significant difference in prosthesis survival rates between the two groups (Log-rank test: χ2=2.028, P=0.154). Conclusion TKA performed with domestic cementless knee prostheses featuring 3D-printed trabecular metal interface shows no obvious disadvantages compared with cemented prostheses in terms of postoperative function, complication rate, and prosthesis survival rate, which represents a safe and viable prosthesis option.
Objective To summarize the technological evolution, clinical advantages, and cutting-edge development trends of cementless prostheses for total knee arthroplasty (TKA), so as to provide a reference for the clinical treatment of end-stage knee osteoarthritis and the research and development of prosthesis technology. MethodsRelevant researches and technical achievements over more than 40 years in the field of cementless prostheses for TKA were systematically reviewed. This study focused on iterative upgrades and carried out comprehensive analysis combined with clinical application data and revision-related studies. Results Benefiting from the advantage of cementless fixation, cementless prostheses can effectively avoid bone-cement-related complications. Prosthesis coating materials have undergone multi-generation iterations, and friction-interface materials present favourable prospects for bionic-oriented application. Robot-assisted surgical systems can markedly improve the primary-fixation reliability of biological prostheses.Conclusion Materials and surgical-assisted techniques for cementless prostheses keep being innovated and their clinical outcomes are continuously optimized. Artificial-intelligence-aided surgical planning and patient-specific customized prostheses will become the core research directions in this field.