第一代和第二代Harris-Galante髋臼组件中聚乙烯内衬的移位。18例报告。

Dislodgment of polyethylene liners in first and second-generation Harris-Galante acetabular components. A report of eighteen cases.

作者信息

González della Valle A, Ruzo P S, Li S, Pellicci P, Sculco T P, Salvati E A

机构信息

The Hospital for Special Surgery, New York City, USA.

出版信息

J Bone Joint Surg Am. 2001 Apr;83(4):553-9. doi: 10.2106/00004623-200104000-00010.

DOI:10.2106/00004623-200104000-00010

PMID:11315784

Abstract

BACKGROUND

Dislodgment of the polyethylene liner is an increasingly common complication following total hip arthroplasty. The purposes of this study are to present the results in a series of patients with this complication and to analyze the mode of failure.

METHODS

Between November 1995 and January 2001, eighteen patients who had had a total hip arthroplasty presented with dislodgment of the polyethylene liner from a Harris-Galante metal acetabular shell. The medical records, radiographs, operative notes, and retrieved components were reviewed. In addition, scanning electron microscopy was used to study the fractured surfaces in a shell that had four broken tines.

RESULTS

The components had been in situ for an average of seven years (range, three to eleven years). Seventeen components were second generation, and one was first generation. Symptoms developed spontaneously in sixteen patients, during sexual intercourse in one, and following a fall on the hip in one. Radiographs showed eccentric positioning of the head in all of the hips and broken tines in six. All of the shells were well fixed. Treatment consisted of revision of the shell in four patients, exchange of the liner in four, cementation of a new liner into the shell in seven, and cementation of an all-polyethylene cup in three. The liners had severe damage of the rim. Scanning-electron microscopy of the fractured surfaces of four tines revealed a fatigue pattern.

CONCLUSIONS

We believe that, as the liner wears and becomes loose because of an inadequate locking mechanism, progressive micromotion occurs and the load increases on the polyethylene rim until it deforms and/or fractures. Subsequently, nothing prevents the liner from rotating out of the shell. As this mechanism of failure appears to include fatigue failure of the locking tines and wear of the liner, this complication is likely to increase as the components age in situ.

摘要

背景

聚乙烯内衬脱位是全髋关节置换术后日益常见的并发症。本研究的目的是报告一系列出现该并发症患者的治疗结果，并分析失败模式。

方法

1995年11月至2001年1月期间，18例接受全髋关节置换术的患者出现聚乙烯内衬从Harris-Galante金属髋臼杯脱位。回顾了病历、X线片、手术记录和取出的假体组件。此外，还使用扫描电子显微镜研究了一个有四个锁扣齿断裂的髋臼杯的断裂表面。

结果

假体组件在位平均7年（范围3至11年）。17个组件为第二代，1个为第一代。16例患者症状自发出现，1例在性交过程中出现，1例在髋部跌倒后出现。X线片显示所有髋关节的股骨头均有偏心定位，6例有锁扣齿断裂。所有髋臼杯均固定良好。4例患者接受髋臼杯翻修治疗，4例更换内衬，7例将新内衬粘固到髋臼杯中，3例粘固全聚乙烯髋臼杯。内衬边缘有严重损伤。对四个锁扣齿的断裂表面进行扫描电子显微镜检查显示为疲劳模式。