Comparative Survival of Uncemented Acetabular Components Following Primary Total Hip Arthroplasty
Comparative Survival of Uncemented Acetabular Components Following Primary Total Hip Arthroplasty
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DOI：
10.2106/jbjs.j.00195
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发表时间：
2011-09-07
影响因子：
5.3
通讯作者：
Lewallen, David G.
中科院分区：
文献类型：
--
作者：
Howard, James L.;Kremers, Hilal Maradit;Lewallen, David G.
背景：自从20世纪80年代初首次引入非骨水泥髋臼假体以来，非骨水泥髋臼假体已经成为美国大多数髋关节置换手术的首选植入类型。本研究的目的是比较初次全髋关节置换术后非骨水泥髋臼假体存活率的差异。方法：研究对象为1984年1月至2004年12月在梅奥诊所接受9584例初次全髋关节置换术的7989名患者，其中包括20种不同类型的非骨水泥髋臼假体。使用年龄和性别调整的Cox比例风险回归模型比较不同假体的总体存活率和因特定原因(无菌性松动、磨损、骨溶解)而不翻修的存活率。结果：珠状和羟基磷灰石涂层髋臼假体翻修的风险明显高于钛网假体。交联型聚乙烯的表现好于传统聚乙烯，但这一发现并未达到显著水平。衬垫升高与无菌松动导致翻修杯的风险显著相关。结论：不同类型非骨水泥髋臼假体在全髋关节置换术后的长期存活率有显著差异。初次全髋关节置换术后第二个十年内翻修风险的增加是一个令人担忧的问题，主要是由于聚乙烯磨损、骨溶解和假体松动导致翻修率的稳步增加。证据水平：预后水平III。有关证据水平的完整描述，请参阅对作者的说明。
Background: Since their initial introduction in the early 1980s, uncemented acetabular components have become the preferred implant type for the majority of hip arthroplasties performed in the United States. The purpose of the present study was to compare differences in the survival of uncemented acetabular components following primary total hip arthroplasty.Methods: The study population included 7989 patients who had undergone 9584 primary total hip arthroplasties with twenty different types of uncemented acetabular components at the Mayo Clinic from January 1984 to December 2004. The overall rate of survival as well as the rate of survival free of revision for specific reasons (aseptic loosening, wear, osteolysis) were compared among the different components using age and sex-adjusted Cox proportional hazards regression models.Results: The risk of acetabular cup revision was significantly higher for beaded and hydroxyapatite-coated designs as compared with titanium wire mesh designs. Cross-linked polyethylene performed better than conventional polyethylene, but this finding did not reach significance. Elevated liners were associated with a significantly higher risk of cup revision due to aseptic loosening.Conclusions: There are significant differences in the long-term survival of different types of uncemented acetabular components following total hip arthroplasty. The increased risk of revisions in the second decade after the initial total hip arthroplasty is a concern and is largely due to a steady increase in revisions because of polyethylene wear, osteolysis, and component loosening more than ten years after the time of the index arthroplasty.Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.