The porous-coated anatomic total hip prosthesis: Failure of the metal-backed acetabular component
The porous-coated anatomic total hip prosthesis: Failure of the metal-backed acetabular component
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DOI：
10.2106/00004623-199605000-00016
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发表时间：
1996-05-01
影响因子：
5.3
通讯作者：
Li, S
中科院分区：
文献类型：
--
作者：
Astion, DJ;Saluan, P;Li, S
从1983年到1987年，三位外科医生使用最初设计的多孔涂层解剖假体进行了199例全髋关节置换术。髋臼假体是一种预先组装的金属背衬聚乙烯装置，在金属背衬上烧结珠子以允许骨向内生长，并使用两个钉子进行初步固定。23个髋臼假体(12%)因移位或严重骨溶解而失效。骨溶解的影像表现与种植体在原位的时间呈正相关(p<；0.001)。外径在55毫米或以下(聚乙烯厚度在8.5毫米或以下)的髋臼假体中，骨溶解的发生率也明显更高(p=0.03)。术后13个髋关节平均翻修69.5个月(33~91个月)。髋臼假体取出后检查发现关节和衬垫背面广泛的聚乙烯损伤。常见的发现是衬里聚乙烯环的裂纹和聚乙烯环上的防旋转缺口变形。聚乙烯的密度比预期的要大，没有熔化的颗粒比预期的要多，与周围的聚乙烯一样。这项研究的结果表明，与设计和材料有关的因素导致了这些多孔涂层解剖髋臼假体的失败。临床相关性：对于最初设计的多孔涂层解剖髋臼假体进行了全髋关节置换术的患者，临床上应该密切监测疼痛的发生，并对假体发生溶骨性病变或移位进行放射学检查。这些发现与假体即将失效有关，可能需要对这部分髋关节置换术进行翻修。
One hundred and ninety-nine total hip arthroplasties were performed, between 1983 and 1987, in 173 patients by three surgeons using the initial design of the porous-coated anatomic prosthesis. The acetabular component was a preassembled, metal-backed polyethylene device, with beads sintered to the metal backing to allow bone ingrowth and two pegs for initial fixation. Twenty-three acetabular components (12 per cent) failed because of either migration or severe osteolysis. The radiographic appearance of osteolysis was positively associated with the duration that the implant had been in situ (p < 0.001). The prevalence of osteolysis was also significantly greater in acetabular components with an outer diameter of fifty-five millimeters or less (a polyethylene thickness of 8.5 millimeters or less) (p = 0.03). Thirteen hips were revised at a mean of 69.5 months (range, thirty-three to ninety-one months) after the index operation.Examination of the retrieved acetabular components revealed extensive polyethylene damage on the articular and back surfaces of the liners. Cracks in the polyethylene rim of the liner and deformation of the anti-rotation notch in the polyethylene rim were common findings. The density of the polyethylene was greater than expected, and more particles than anticipated had not fused,vith the surrounding polyethylene. The results of this study suggest that factors related to both the design and the material contributed to the failure of these porous-coated anatomic acetabular components.CLINICAL RELEVANCE: Patients who have had a total hip arthroplasty with the initial design of the porous-coated anatomic acetabular component should be closely monitored clinically for the onset of pain and radiographically for the development of osteolytic lesions or migration of the component. These findings are associated with impending failure of the component and may warrant revision of this portion of the hip replacement.