Perspectives on metaphyseal conservative stems

被引：81
作者：
Falez F. [1 ]
Casella F. [1 ]
Panegrossi G. [1 ]
Favetti F. [1 ]
Barresi C. [1 ]
机构：
[1] Department Orthopaedic and Traumatology, S. Spirito in Sassia Hospital, 00100 Rome
来源：
Journal of Orthopaedics and Traumatology | 2008年 / 9卷 / 1期
关键词：
Arthroplasty; Conservative; DEXA; Hip; Metaphyseal;
D O I：
10.1007/s10195-008-0105-4
中图分类号：
学科分类号：
摘要：
Total hip replacement is showing, during the last decades, a progressive evolution toward principles of reduced bone and soft tissue aggression. These principles have become the basis of a new philosophy, tissue sparing surgery. Regarding hip implants, new conservative components have been proposed and developed as an alternative to conventional stems. Technical and biomechanical characteristics of metaphyseal bone-stock-preserving stems are analyzed on the basis of the available literature and our personal experience. Mayo, Nanos and Metha stems represent, under certain aspects, a design evolution starting from shared concepts: reduced femoral violation, non-anatomic geometry, proximal calcar loading and lateral alignment. However, consistent differences are level of neck preservation, cross-sectional geometry and surface finishing. The Mayo component is the most time-tested component and, in our hands, it showed an excellent survivorship at the mid-term follow-up, with an extremely reduced incidence of aseptic loosening (partially reduced by the association with last generation acetabular couplings). For 160 implants followed for a mean of 4.7 years, survivorship was 97.5% with 4 failed implants: one fracture with unstable stem, 1 septic loosening and 2 aseptic mobilizations. DEXA analysis, performed on 15 cases, showed a good calcar loading and stimulation, but there was significant lateral load transfer to R3-R4 zones, giving to the distal part of the stem a function not simply limited to alignment. Metaphyseal conservative stems demonstrated a wide applicability with an essential surgical technique. Moreover, they offer the options of a conservative revision" with a conventional primary component in case of failure and a "conservative revision" for failed resurfacing implants. © Springer-Verlag Italia 2008."
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页码：49 / 54
页数：5
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