Ten-year results of a double-heat-treated metal-on-metal hip resurfacing
Ten-year results of a double-heat-treated metal-on-metal hip resurfacing
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DOI：
10.1302/0301-620x.92b1.21530
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发表时间：
2010-01-01
影响因子：
--
通讯作者：
McMinn, D. J. W.
中科院分区：
文献类型：
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作者：
Daniel, J.;Ziaee, H.;McMinn, D. J. W.
第二代金属对金属轴承的引入是为了应对与传统更换相关的相当高的磨损导致故障的发生率，特别是在年轻患者中。我们介绍了连续十年使用金属对金属髋关节表面重建术治疗的一系列患者的结果。我们系列中使用的轴承的一个明显特点是，它们在制造的后铸造阶段进行了双重热处理。在过去，这些轴承没有进行过热处理，这是一种独特的金属对金属支架，以前从未在临床实践中使用过。我们报告了1996年间使用混合固定金属对金属髋关节表面重建术治疗连续184个髋关节(160名患者)的结果。患者被邀请进行至少十年的临床放射学随访。获得牛津髋关节评分和正位、侧位X线片。手术时平均年龄54岁(21~75岁)。以1994年3月至1995年12月连续107例(99个)髋关节假体植入后一次性热处理的患者为对照组，其中7例(7个髋关节)死于非相关原因，4例(4%)因骨溶解和无菌性松动而翻修。在1996年组中，有9名患者因无关原因在术后平均6.9年死亡。翻修30次(16%)，平均7.3年(1.2~10.9)，1次为感染，29次为骨溶解和无菌性松动。此外，在后一组中，在111个存活的髋关节中有27个(24%)有放射学失败的迹象。1996年的队列中骨溶解和无菌性松动的问题直到手术后5年才变得明显。我们的结果表明，金属对金属轴承的双重热处理可以导致磨损诱导的骨溶解的发生率增加。
Second-generation metal-on-metal bearings were introduced as a response to the considerable incidence of wear-induced failures associated with conventional replacements, especially in young patients. We present the results at ten years of a consecutive series of patients treated using a metal-on-metal hip resurfacing. A distinct feature of the bearings used in our series was that they had been subjected to double-heat treatments during the post-casting phase of their manufacture. In the past these bearings had not been subjected to thermal treatments, making this a unique metal-on-metal bearing which had not been used before in clinical practice.We report the outcome of 184 consecutive hips (160 patients) treated using a hybrid-fixed metal-on-metal hip resurfacing during 1996. Patients were invited for a clinicoradiological follow-up at a minimum of ten years. The Oxford hip score and anteroposterior and lateral radiographs were obtained. The mean age at operation was 54 years (21 to 75). A series of 107 consecutive hips (99 patients) who received the same prosthesis, but subjected to a single thermal treatment after being cast, between March 1994 and December 1995, were used as a control group for comparison.In the 1994 to 1995 group seven patients (seven hips) died from unrelated causes and there were four revisions (4%) for osteolysis and aseptic loosening. In the 1996 group nine patients died at a mean of 6.9 years after operation because of unrelated causes. There were 30 revisions (16%) at a mean of 7.3 years (1.2 to 10.9), one for infection at 1.2 years and 29 for osteolysis and aseptic loosening. Furthermore, in the latter group there were radiological signs of failure in 27 (24%) of the 111 surviving hips.The magnitude of the problem of osteolysis and aseptic loosening in the 1996 cohort did not become obvious until five years after the operation. Our results indicate that double-heat treatments of metal-on-metal bearings can lead to an increased incidence of wear-induced osteolysis.