Gaffey John L, Callaghan John J, Pedersen Douglas R, Goetz Devon D, Sullivan Patrick M, Johnston Richard C
Department of Orthopaedics, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, Iowa 52242, USA.
J Bone Joint Surg Am. 2004 Feb;86(2):257-61.
Loosening of the acetabular component is the major long-term problem associated with total hip arthroplasty with cement. The purpose of the present study was to evaluate the minimum thirteen-year results associated with cementless acetabular components that had been inserted by a single surgeon and to compare them with the results associated with cemented acetabular components that had been inserted by the same surgeon.
One hundred and twenty consecutive, nonselected primary total hip replacements were performed in 108 patients with use of a Harris-Galante-I cementless acetabular component and a cemented femoral component with a 28-mm head. The patients were evaluated clinically with use of a standard terminology questionnaire, and they were evaluated radiographically for loosening, component migration, wear, and osteolysis. The rates of revision for aseptic loosening and radiographic evidence of loosening for this cohort were compared with the rates for four previously reviewed consecutive series of hips in which the acetabular component had been inserted with cement. All patients were managed by the same surgeon, were followed for thirteen to fifteen years, and were evaluated with use of the same two criteria (revision and loosening) as the end points for Kaplan-Meier analysis.
Sixty-six patients (seventy-two hips) were living and forty-two patients (forty-eight hips) had died after thirteen to fifteen years of follow-up. No acetabular component had been revised because of aseptic loosening, and no acetabular component had migrated. With revision of the acetabular component for any reason as the end point, the survival rate was 81% +/- 8% at fifteen years. With revision of the acetabular component for clinical failure (osteolysis, wear, loosening, or dislocation) as the end point, the survival rate was 94% +/- 8% at fifteen years. Among the seventy hips with at least thirteen years of radiographic follow-up, five had pelvic osteolysis and three had had revision of a well-fixed acetabular component because of pelvic osteolysis secondary to polyethylene wear. The mean linear wear rate was 0.15 mm/yr (0.12 mm/yr when one outlier was excluded).
In terms of fixation, Harris-Galante-I cementless acetabular components performed better than did cemented 22-mm-inner-diameter Charnley acetabular components as well as 28-mm-inner-diameter all-polyethylene and metal-backed acetabular components that had been inserted by the same surgeon. However, the rate of wear was greater in association with the Harris-Galante-I cementless components than it was in association with the Charnley cemented all-polyethylene components.
髋臼组件松动是骨水泥型全髋关节置换术的主要长期问题。本研究的目的是评估由单一外科医生植入的非骨水泥型髋臼组件至少13年的随访结果，并将其与同一外科医生植入的骨水泥型髋臼组件的结果进行比较。
对108例患者连续进行了120例非选择性初次全髋关节置换术，使用Harris-Galante-I型非骨水泥型髋臼组件和一个带28毫米股骨头的骨水泥型股骨组件。使用标准术语问卷对患者进行临床评估，并对其进行放射学评估，以检查松动、组件移位、磨损和骨溶解情况。将该队列中无菌性松动的翻修率和松动的放射学证据发生率与之前回顾的四个连续系列髋关节的发生率进行比较，这四个系列的髋关节中髋臼组件采用骨水泥植入。所有患者均由同一位外科医生治疗，随访13至15年，并使用相同的两个标准（翻修和松动）作为Kaplan-Meier分析的终点进行评估。
经过13至15年的随访，66例患者（72髋）存活，42例患者（48髋）死亡。没有髋臼组件因无菌性松动而翻修，也没有髋臼组件发生移位。以因任何原因翻修髋臼组件作为终点，15年时的生存率为81%±8%。以因临床失败（骨溶解、磨损、松动或脱位）翻修髋臼组件作为终点，15年时的生存率为94%±8%。在至少有13年放射学随访的70髋中，5髋出现骨盆骨溶解，3髋因聚乙烯磨损继发骨盆骨溶解而对固定良好的髋臼组件进行了翻修。平均线性磨损率为0.15毫米/年（排除一个异常值后为0.12毫米/年）。
在固定方面，Harris-Galante-I型非骨水泥型髋臼组件的表现优于同一外科医生植入的内径22毫米的Charnley骨水泥型髋臼组件以及内径28毫米的全聚乙烯和金属背衬髋臼组件。然而，Harris-Galante-I型非骨水泥组件的磨损率高于Charnley骨水泥型全聚乙烯组件。
