Same survival but higher rate of osteolysis for metal-on-metal Ultamet versus ceramic-on-ceramic in patients undergoing primary total hip arthroplasty after 8 years of follow-up
Same survival but higher rate of osteolysis for metal-on-metal Ultamet versus ceramic-on-ceramic in patients undergoing primary total hip arthroplasty after 8 years of follow-up
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DOI：
10.1016/j.otsr.2018.08.005
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发表时间：
2018-12-01
影响因子：
2.3
通讯作者：
Ishiguro, Naoki
中科院分区：
文献类型：
--
作者：
Higuchi, Yoshitoshi;Seki, Taisuke;Ishiguro, Naoki
背景：为了避免磨损引起的骨质溶解，已经开发了陶瓷对陶瓷（CoC）和金属对金属（MoM）关节面。目前，在5年以上随访时，CoC和MoM非骨水泥型全髋关节置换术之间没有直接的材料相关临床比较。更有可能防止骨溶解的关节面仍有争议。因此，我们进行了一项回顾性病例对照研究，评价CoC和MoM非骨水泥型THA，以便：-比较术后5-10年CoC和MoM THA的寿命和并发症;-比较两种类型THA之间的骨质溶解发生率;-评价MoM THA中的假瘤。假设：CoC THA的骨质溶解发生率较低，寿命较长，临床结局优于MoM THA。患者和方法：96例髋关节接受CoC THA，56例髋关节接受MoM THA（Ultamet，Pinnacle，Depuy）。手术时患者平均年龄为57.1岁（范围：28 - 77岁）。结果：Harris髋关节评分无差异（CoC组和MoM组分别为89.5和90.3）。与CoC THA（2例髋关节，2.1%）相比，MoM THA中观察到的骨质溶解（9例髋关节，14.3%）明显更频繁。以植入物松动或翻修THA为终点的8年Kaplan-Meier生存率，CoC为98.2%（95% CI：87.8-99.8），MoM为98.6%（95% CI：90.2-99.8）（p = 0.684）。CoC全髋关节置换术中有一次可听到的吱吱声（1.0%），无陶瓷断裂。5例（8.9%）髋关节在MoM THA中显示假瘤。讨论：CoC THA的骨质溶解发生率较低。当使用植入物松动和翻修THA作为终点时，植入物之间的8年生存率没有显著差异。这些数据表明，与MoM THA相比，CoC THA具有良好的临床和影像学结局。与其他MoM胫骨平台相比，Ultamet MoM的骨溶解率更高;髋臼杯组配性（不含聚乙烯）和使用36 mm股骨头以及生产过程（2006年之后）可能在较高的骨溶解率中发挥重要作用。(C)2018年Elsevier Masson SAS。All rights reserved.
Background: To avoid wear-induced osteolysis, ceramic-on-ceramic (CoC) and metal-on-metal (MoM) bearings have been developed. At present, there are no direct material related clinical comparisons between cementless total hip arthroplasty with CoC and MoM at more than 5-year follow-up. The bearing that is more likely to prevent osteolysis is still controversial. Therefore, we performed a retrospective case control study evaluating CoC and MoM cementless THAs in order to:-compare the longevity and complications for CoC and MoM THAs at 5-10 years postoperatively;-compare the incidence of osteolysis between both type THAs;-evaluate pseudotumors in MoM THAs.Hypothesis: CoC THAs will have a lower rate of osteolysis, better longevity, and better clinical outcomes than MoM THAs.Patients and methods: Ninety-six hips underwent CoC THAs, and 56 hips underwent MoM THA (Ultamet, Pinnacle, Depuy). Average patient age at the time of surgery was 57.1 years (range, 28 to 77 years).Results: There were no differences with regard to the Harris hip score (89.5 and 90.3 for the CoC and MoM groups, respectively). Osteolysis (9 hips, 14.3%) among MoM THAs were significantly more frequently observed compared to CoC THAs (2 hips, 2.1%). Kaplan-Meier survival at 8 years with implant loosening or revision THA as the endpoint was 98.2% (95% CI: 87.8-99.8) for CoC, and 98.6% (95% CI: 90.2-99.8) for MoM (p = 0.684). There was one audible squeaking (1.0%) and no ceramic fracture among CoC THAs. Five (8.9%) hips showed pseudotumors among MoM THAs.Discussion: CoC THAs had a low incidence of osteolysis. No significant difference was seen in the 8-year survival rate between implants, when using implant loosening and revision THA as endpoints. These data indicate that CoC THAs have excellent clinical and radiological outcomes, compared with MoM THAs. Ultamet MoM had a higher rate of osteolysis compared to other MoM bearings; the cup modularity (without polyethylene) and the use of 36 mm heads as well as the process of production (after 2006) may play a significant role in the higher rate of osteolysis. (C) 2018 Elsevier Masson SAS. All rights reserved.