Reemplazo total de cadera con un tallo corto no cementado tipo 2B: resultados a los 2-5 años de seguimiento. [Total hip replacement with a short cementless stem type 2B: Results of 2 to 5 years of follow-up]

Martín Buttaro, Francisco Nally, Ricardo Salcedo, Pablo Ariel Slullitel, José Ignacio Oñativia, Fernando Comba, Francisco Piccaluga

Resumen


Objetivo: Determinar los resultados clínicos, la supervivencia y la incidencia de fractura periprotésica intraoperatoria con un tallo corto tipo 2B de fijación cervicometafisaria.

Métodos: Se analizaron prospectivamente los primeros 100 tallos (84 pacientes) MiniHipTM (Corin, Cirencester, Reino Unido) colocados, en forma consecutiva, por un mismo cirujano. La edad promedio fue de 47 años. La indicación para un tallo corto fue: edad <55 años (85 casos) o la participación previa en deportes de impacto en pacientes de entre 56 y 60 años (15 casos). El diagnóstico inicial fue artrosis primaria de cadera en el 82% de los casos. El seguimiento promedio fue de 42 meses.

Resultados: El puntaje en la escala de Harris modificada mejoró de 55 a 96 al final del seguimiento (p = 0,02) y ningún paciente refirió dolor de muslo en el posoperatorio. La supervivencia del tallo fue del 99% (IC95% 93,1-99,8). Un caso presentó una perforación de la cortical lateral intraoperatoria, tratado con revisión con un tallo no cementado convencional. Un paciente tuvo una infección aguda, que fue tratada con desbridamiento, retención de componentes y antibióticos, con resultado favorable a los 48 meses de la cirugía. Se produjeron 3 fracturas incompletas del calcar intraoperatorias (3%).

Conclusiones: Se obtuvieron resultados excelentes en esta serie de pacientes jóvenes y activos operados por un mismo cirujano con un tallo corto tipo 2B, a los 2-5 años de seguimiento, con un 1% de falla por falsa vía femoral intraoperatoria.

 

Abstract

Objectives: We sought to determine our 2 to 5-year survivorship, intraoperative fractures, subsidence and thigh pain rate in a consecutive, independent, one surgeon series of patients in whom a type-2B short stem was implanted.

Patients and Methods: The first 100 type 2B consecutive short femoral stems implanted in 84 patients with a mean age of 47 years old were reviewed. Indications included age younger than 55 years (85 hips), or participation in impact sports in patients aging 56 to 60 years old (15 hips). Initial diagnosis was osteoarthritis in 82% of the cases. Median follow-up was 42 months.

Results: Stem survival rate was 99% at 2 to 5 years for stem revision for any aseptic reason and 98% when infection was included. The mean Harris Hip Score improved significantly from 55 to 96 at final follow-up (p 0.02). There was one lateral cortex perforation, and three intraoperative calcar incomplete fractures (3%), only one of them required cerclage wiring and delayed weightbearing. No patient referred thigh pain at final follow-up. Only one case subsided 4 mm and then stabilized. The risk of revision was 1% at 2 to-5 years (95%CI 93.1-99.8%).

Conclusions: Promising short-term results with this design were observed in this single surgeon, non-designerconsecutive series including the learning curve period using a type 2B short stem in young active patients, in which bone preservation is justified.


Palabras clave


Artroplastía; tallo corto no cementado; artrosis de cadera; total hip arthroplasty; cementless short stem; hip osteoarthritis.

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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.2.856

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Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

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