Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing
Long-term comparative study of large-diameter metal-on-metal bearings: Resurfacing versus total arthroplasty with large-diameter Durom™ bearing
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DOI：
10.1016/j.otsr.2019.04.006
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发表时间：
2019-09-01
影响因子：
2.3
通讯作者：
Girard, Julien
中科院分区：
文献类型：
--
作者：
Ridon, Pierre-Emmanuel;Putman, Sophie;Girard, Julien
简介：使用大直径金属对金属（MoM）关节面的全髋关节置换术（THA）的短期结果令人鼓舞，但长期报告的失败率较高，特别是由于模块化导致的腐蚀。有几项研究比较了表面置换（不适用组配式）与大直径MoM THA;但是，据我们所知，没有一项研究在两种情况下比较了随访超过10年的相同关节面。因此，我们进行了一项回顾性病例对照研究，使用单个髋臼杯模型（Durom（TM），Zimmer，Warsaw，USA）进行表面置换（R）和大直径THA，以确定组配性在大直径MoM关节面失效中的作用。该研究比较了（1）金属离子水平，（2）R和THA.Hypothesis之间的生存率、功能评分和并发症发生率：大直径MoM关节面失效与关节面磨损无关，但与大直径MoM THA.Material和方法中的头颈部连接模块化有关：2004年2月至2006年3月期间纳入了83例THA和90例R。所有患者的临床和放射学随访与铬（Cr）和钴（Co）离子blood assayment.Results：在THA组，24 83例（28.9%）进行了修订的不良反应金属碎片（ARMD），而没有在R组。R组的10年全因生存率（97.7%; 95% CI，96.2-99.2）显著优于THA组（67.1%; 95% CI，60.9-73.3）。THA组的中位血离子水平（钴和铬之间的差异：分别为5.75 μ g/L（范围，3.82-19.2）和1.75 μ g/L（范围，1.34-2.94））高于R组（无差异：分别为0.89 μ g/L（范围，0.67-2.89）和1.07 μ g/L（范围，0.67-1.65））。在THA组中，Co和Cr升高与植入物翻修之间存在正相关性（均p < 0.0001）。THA组的Co/Cr比值（2.57）显著高于R组（0.88）（p < 0.0001），24例THA翻修组的Co/Cr比值（4.67）再次升高。平均PMA评分无显著差异（THA：17.08 +/- 1.82（范围，7-18）; R：17.50 +/- 0.74（范围，15-18）），而平均牛津评分更好的R（14.32 +/- 2.5（范围，12-24））比THA（18.17 +/- 8.05（范围，12-42））（p = 0.02）.讨论：本研究证实了模块化在大直径MoM THA失败中的无可争议的意义，通过分析THA和表面置换中的相同关节面。在24例翻修病例中观察到耳轴突出，THA适配环引起严重的金属离子释放（游离的Co/Cr比），这是翻修率较高的原因。(C)2019年由Elsevier Masson SAS出版。
Introduction: Short-term results in total hip arthroplasty (THA) with large-diameter metal-on-metal (MoM) bearings were encouraging, but high failure rates have been reported in the long term, notably implicating corrosion due to modularity. Several studies compared resurfacing (to which modularity does not apply) versus large-diameter MoM THA; but, to our knowledge, none compared the same bearing in the two situations with more than 10 years' follow-up. We therefore conducted a retrospective case-control study, using a single cup model (Durom (TM), Zimmer, Warsaw, USA) for both resurfacing (R) and large-diameter THA, to determine the role of modularity in failure of large-diameter MoM bearings. The study compared (1) metallic ion levels, and (2) survival, functional scores and complications rates between R and THA.Hypothesis: Large-diameter MoM bearing failure implicates not bearing wear but head-neck junction modularity in larger-diameter MoM THA.Material and method: Eighty-three THAs and 90 Rs were included between February 2004 and March 2006. All patients had clinical and radiologic follow-up with chromium (Cr) and cobalt (Co) ion blood assay.Results: In the THA group, 24 of the 83 patients (28.9%) underwent revision for adverse reaction to metal debris (ARMD), versus none in the R group. Ten-year all-cause survival was significantly better in R (97.7%; 95% CI, 96.2-99.2) than THA (67.1%; 95% CI, 60.9-73.3). Median blood ion level was higher in THA (with a difference between Co and Cr: 5.75 mu g/L (range, 3.82-19.2) versus 1.75 mu g/L (range, 1.34-2.94) respectively) than in R (no difference: 0.89 mu g/L (range, 0.67-2.89) and 1.07 mu g/L (range, 0.67-1.65) respectively). In the THA group, there were positive correlations between Co and Cr elevation and implant revision (both p < 0.0001). Co/Cr ratio was significantly higher in THA (2.57) than R (0.88) (p < 0.0001), and higher again in the 24 cases of THA revision (4.67). There was no significant difference in mean PMA score (THA: 17.08 +/- 1.82 (range, 7-18); R: 17.50 +/- 0.74 (range, 15-18)), whereas mean Oxford score was better in R (14.32 +/- 2.5 (range, 12-24)) than THA (18.17 +/- 8.05 (range, 12-42)) (p = 0.02).Discussion: The present study confirmed the incontrovertible implication of modularity in failure of large-diameter MoM THA, by analyzing the same bearing in THA and in resurfacing. Trunnionosis was observed in the 24 cases of revision, with the THA adaptation ring inducing serious metallic ion release (with dissociated Co/Cr ratio), accounting for the high rate of revision. (C) 2019 Published by Elsevier Masson SAS.