Garellick G, Malchau H, Regnér H, Herberts P
Department of Orthopaedics, Institute of Surgical Sciences, Sahlgrenska University Hospital, Göteborg University, Sweden.
J Arthroplasty. 1999 Jun;14(4):414-25. doi: 10.1016/s0883-5403(99)90096-7.
A total of 410 hips were randomized to treatment with either a Charnley (206 hips) or a Spectron (204 hips) total hip arthroplasty. The patients were operated on by a standardized procedure using a contemporary cementing technique and were followed after 1, 3, 5 to 6, and 10 years. The postoperative radiographs showed a significantly increased rate of malalignment and consequently low grade of cement mantle quality of the Charnley stem compared to the Spectron. No differences concerning cement mantle quality or positioning were found between the Charnley ogee cup and the metal-backed Spectron. Evaluation of the follow-up radiographs revealed 10 loose Charnley stems and 1 loose Spectron stem and 4 loose Charnley ogee cups and 23 loose Spectron metal-backed cups. The differences of revision rate for the femoral and acetabular components of the 2 prostheses were significant (P = .03, Charnley femoral component more frequent; P = .03, Spectron acetabular component more frequent). The radiographic evaluation strengthened this disparity. Poor wear characteristics of the metal-backed Spectron cup are perhaps the main reason for the highly significant difference in mechanical failure rate between the 2 cups. We therefore propose that metal-backing of cemented cups should be avoided, at least when combined with larger femoral heads. The difficulty in positioning the Charnley stem with an adequate cement mantle, especially in the absence of trochanteric osteotomy, might explain the inferior Charnley stem longevity in this study.
总共410例髋关节被随机分为接受Charnley型（206例髋关节）或Spectron型（204例髋关节）全髋关节置换术治疗。患者通过采用当代骨水泥技术的标准化手术流程进行手术，并在术后1年、3年、5至6年以及10年进行随访。术后X线片显示，与Spectron型相比，Charnley型假体柄的对线不良率显著增加，因此骨水泥壳质量等级较低。Charnley型S形臼杯与金属背衬的Spectron型之间在骨水泥壳质量或位置方面未发现差异。对随访X线片的评估显示，有10例Charnley型假体柄松动、1例Spectron型假体柄松动、4例Charnley型S形臼杯松动以及23例Spectron型金属背衬臼杯松动。两种假体的股骨和髋臼组件翻修率差异具有统计学意义（P = 0.03，Charnley型股骨组件更常见；P = 0.03，Spectron型髋臼组件更常见）。X线评估强化了这种差异。金属背衬的Spectron型臼杯磨损特性较差可能是两种臼杯机械故障率存在高度显著差异的主要原因。因此，我们建议应避免使用骨水泥固定臼杯的金属背衬，至少在与较大股骨头组合使用时应如此。在没有转子截骨术的情况下，难以将Charnley型假体柄放置在合适的骨水泥壳中，这可能解释了本研究中Charnley型假体柄使用寿命较短的原因。
