Factors affecting aseptic failure of fixation after primary charnley total hip arthroplasty - Multivariate survival analysis
Factors affecting aseptic failure of fixation after primary charnley total hip arthroplasty - Multivariate survival analysis
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DOI：
10.2106/00004623-199711000-00002
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发表时间：
1997-11-01
影响因子：
5.3
通讯作者：
Hisa, K
中科院分区：
文献类型：
--
作者：
Kobayashi, S;Takaoka, K;Hisa, K
采用考克斯比例风险模型对246例患者进行的293例Charnley全髋关节置换术进行多变量生存分析。分析的目的是确定无菌性固定失败的风险因素，并量化其影响。随访时间从1个月到23个疤痕（平均13年）。生存终点定义为影像学证实固定失败或翻修手术，髋臼假体固定失败定义为完全分界或移位。股骨部件失效定义为5种术后体征（下沉、骨水泥分界、部件与骨水泥分离、骨水泥断裂和骨内膜空化）中至少1种的进展或至少2种这些体征的发生。每个髋臼部件的24个特定数据项和每个股骨部件的30个特定数据项形成了用于分析的变量集。16年的存活率（95%置信区间）髋臼部件为83.6 +/-5.6%，股骨部件为90.9 +/-4.1%。以翻修作为终点，16年生存率分别为92.3 +/-4.0%和95.6 +/-3.2%。影响髋臼假体放射学松动的最重要风险因素是聚乙烯的快速磨损（每年0.2 mm或以上），其次是根据骨赘形成的程度对骨关节病进行分类（肥大性、正常性或萎缩性）。肥大性骨关节病组的髋关节窝存活时间较其他两组长。根据翻修确定的髋臼假体的存活率仅受聚乙烯快速磨损的影响。股骨假体的存活率，以影像学固定失败或翻修为终点，受到不利的髓腔几何形状（所谓的烟囱管或大髓腔）的影响。对于聚乙烯磨损快、骨赘形成少或髓腔几何形状不利的患者，应仔细随访。这些风险因素需要进一步评估。
Multivariate survival analysis with use of the Cox proportional-hazards model was applied to a consecutive series of 293 primary Charnley total hip arthroplasties performed on 246 patients. The purpose of the analysis was to identify risk factors for, and to quantitate their effects on, aseptic failure of fixation. The duration of follow-up ranged from one month to twenty-three Scars (average, thirteen years). The end point of survival was defined as radiographic evidence of failure of fixation or as a revision operation.Failure of fixation of the acetabular component was defined as complete demarcation or migration. Failure of the femoral component was defined as progression of at least one of five postoperative signs (subsidence, demarcation of the cement, separation of the component from the cement, fracture of the cement, and endosteal cavitation) or as the occurrence of at least two of these signs. Twenty-four specific items of data for each acetabular component and thirty specific items for each femoral component formed the sets of variables for the analysis.With use of radiographic evidence of failure as the end point, the sixteen-year rates of survival (with 95 per cent confidence interval) were 83.6 +/- 5.6 per cent for the acetabular components and 90.9 +/- 4.1 per cent for the femoral components. With use of revision as the end point, the sixteen-year rates of survival were 92.3 +/- 4.0 per cent and 95.6 +/- 3.2 per cent, respectively. The most important risk factor affecting radiographic loosening of the acetabular component,vas rapid wear of the polyethylene (0.2 millimeter or more annually), followed by the classification of the osteoarthrosis (as hypertrophic, normotrophic, or atrophic) according to the extent of osteophyte formation. The sockets in the hips that had hypertrophic osteoarthrosis survived longer than those in the other two groups. Survival of the acetabular component as determined on the basis of revision was affected only by rapid wear of the polyethylene. Survival of the femoral component, with either radiographic failure of fixation or revision as the end point, was affected by an unfavorable geometry of the medullary canal (a so-called stovepipe canal or a large canal).Patients who have rapid wear of the polyethylene, little osteophyte formation, or an unfavorable geometry of the canal should be followed carefully. These risk factors warrant additional evaluation.