Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales
Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales
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DOI：
10.1016/s0140-6736(12)60353-5
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发表时间：
2012-03-31
期刊：
影响因子：
168.9
通讯作者：
Blom, Ashley W.
中科院分区：
文献类型：
--
作者：
Smith, Alison J.;Dieppe, Paul;Blom, Ashley W.
背景 全髋关节置换术（THR）极为常见。有些假体会失效，尤其是年轻患者，需要进行修复，最常见的是因磨损或脱位而导致的松动。外科医生尝试通过植入大直径金属对金属轴承表面来解决这些问题。我们的目的是评估在带柄 THR 中，与其他支撑表面相比，金属对金属支撑表面是否会提高植入物的存活率，此外，较大的头部尺寸是否会提高植入物的存活率。方法我们分析了 2003 年至 2011 年间进行的英格兰和威尔士国家联合登记处初次髋关节置换术（402 051 例，其中 31 171 例为带柄金属对金属）。我们的分析采用多变量灵活参数生存模型来估计协变量调整的累积翻修发生率根据死亡竞争风险进行调整。结果 金属对金属 THR 的失败率很高。失败与头部大小有关，较大的头部失败较早（60 岁男性 5 年内 28 毫米头部翻修累计发生率为 3.2% [95% CI 2.5-4.1]，52 毫米头部翻修累计发生率为 5.1% [4.2-6.2]）。年轻女性的 5 年翻修率为 46 毫米金属对金属的 6.1% (5.2-7.2)，而 28 毫米金属对聚乙烯的 5 年翻修率为 1.6% (1.3-2.1)。相比之下，对于陶瓷对陶瓷关节，较大的头部尺寸与提高的生存率相关（对于 60 岁的男性，28 毫米的 5 年翻修率为 3.3% [2.6-4.1]，40 毫米的 2.0% [1.5-2.7]）。 解释 与其他选择相比，金属对金属柄关节的种植体存活率较差，不宜植入。应仔细监测所有使用这些轴承的患者，特别是植入大直径头部的年轻女性。由于大直径陶瓷陶瓷轴承似乎表现良好，我们支持继续使用它们。
Background Total hip replacement (THR) is extremely common. Some prostheses fail, particularly in younger patients, and need to be revised, most commonly for loosening secondary to wear or dislocation. Surgeons have tried to address these problems by implanting large diameter metal-on-metal bearing surfaces. Our aim was to assess if metal-on-metal bearing surfaces lead to increased implant survival compared with other bearing surfaces in stemmed THR and, additionally, if larger head sizes result in improved implant survival.Methods We analysed the National Joint Registry of England and Wales for primary hip replacements (402 051, of which 31 171 were stemmed metal-on-metal) undertaken between 2003 and 2011. Our analysis was with a multivariable flexible parametric survival model to estimate the covariate-adjusted cumulative incidence of revision adjusting for the competing risk of death.Findings Metal-on-metal THR failed at high rates. Failure was related to head size, with larger heads failing earlier (3.2% cumulative incidence of revision [95% CI 2.5-4.1] for 28 mm and 5.1% [4.2-6.2] for 52 mm head at 5 years in men aged 60 years). 5 year revision rates in younger women were 6.1% (5.2-7.2) for 46 mm metal-on-metal compared with 1.6% (1.3-2.1) for 28 mm metal-on-polyethylene. By contrast, for ceramic-on-ceramic articulations larger head sizes were associated with improved survival (5 year revision rate of 3.3% [2.6-4.1] with 28 mm and 2.0% [1.5-2.7] with 40 mm for men aged 60 years).Interpretation Metal-on-metal stemmed articulations give poor implant survival compared with other options and should not be implanted. All patients with these bearings should be carefully monitored, particularly young women implanted with large diameter heads. Since large diameter ceramic-on-ceramic bearings seem to do well we support their continued use.