Các kỹ thuật phẫu thuật tiếp tục để trở thành tinh chế để cải thiện các kết quả của chính arthroplasty gắn khớp háng. Mặc dù đã có nhiều nghiên cứu-được ở các vùng của ximăng và thiết kế cấy ghép, ít làm việc ĐÃ đã đề cập cụ thể chuẩn bị như thế nào có thể được tối ưu hóa xương ở bên đùi. | Perspectives on Modern Orthopaedics Femoral Preparation in Cemented Total Hip Arthroplasty Reaming or Broaching Christopher W. DiGiovanni MD Kevin L. Garvin MD and Paul M. Pellicci MD Abstract Surgical techniques continue to be refined to improve the results of primary cemented total hip arthroplasty. Although there has been much research in the areas of cementation and implant design little work has specifically addressed how bone preparation can be optimized on the femoral side. On the basis of available scientific data it appears that the broach-only system has several potential advantages over the traditional ream-and-broach technique. Broaching is usually faster leaves behind more bone stock and may improve both microinterlock and macrointerlock. Additionally the excess bone resulting from broaching without reaming does not seem to compromise fixation at the bone-cement interface. Such differences may become even more important as the indications for cemented hip arthroplasty broaden to include increasingly younger and more active patients because revision in these individuals is likely. In most cases reaming is probably counterproductive although it may be advantageous when used to open the femoral canal to prevent varus stem orientation and to manage sclerosis or deformity of bone due to a preexisting hip disorder or the presence of internal fixation devices. Regardless of which method is chosen good bone surface cleansing and cement penetration remain paramount. More studies comparing reamed and nonreamed preparation are necessary to resolve this controversial issue definitively. J Am Acad Orthop Surg 1999 7 349-357 The outcome of primary cemented total hip arthroplasty is dependent on good operative technique. Meticulous surgical craftsmanship not just the presence or absence of cement or the use of a specific implant plays an important role in prosthetic longevity. Most research to date on cemented arthroplasty has focused on means of optimizing the .
