Jones Carroll P, Lachiewicz Paul F
Department of Orthopaedics, University of North Carolina-Chapel Hill, 3151 Bioinformatics, CB 7055, Chapel Hill, NC 27599-7055, USA.
J Bone Joint Surg Am. 2004 Feb;86(2):342-7. doi: 10.2106/00004623-200402000-00018.
There are few longer-term follow-up reports of the results and complications of the use of cementless acetabular components in revision hip arthroplasty. In this study, we analyzed the clinical and radiographic results to determine the factors that affect longer-term survival of titanium-fiber-metal-coated acetabular components.
During a fourteen-year period, one surgeon performed 211 consecutive unselected cementless acetabular revisions in 194 patients with a mean age of sixty-two years. The same technique was used for all revisions: the component was impacted and was fixed with multiple screws, and bone deficiencies were augmented with supplemental bone graft. Both the acetabular and the femoral components were revised in 142 hips, whereas an isolated acetabular revision was performed in sixty-nine hips. All 211 revisions were included in a survivorship analysis to twelve years. Prospectively determined clinical results in 135 hips and radiographic results in 131 hips were available at a minimum of five years postoperatively.
Seven acetabular components were removed: three, because of infection; one, because of recurrent dislocation; and three, because of mechanical loosening. There was asymptomatic radiographic loosening of one additional acetabular component, for a total rate of aseptic loosening of 2%. The twelve-year prosthetic survival rate was 95% (95% confidence interval, 91% to 99%), with failure defined as component removal for any reason. There was no significant difference in the rate of survival of the cup or femoral component between the sixty-nine hips treated with isolated acetabular revision and the 142 hips in which both components were revised. There was a significant difference in the rate of dislocation between the hips treated with isolated acetabular revision (dislocation in fourteen hips, 20%) and those in which both components had been revised (dislocation in eleven hips, 8%; p = 0.03), but there was no difference in component survival if a dislocation occurred. There was a significant association between a patient weight of >82 kg and acetabular failure (p = 0.04).
This titanium-fiber-metal-coated hemispheric component fixed with multiple screws had a twelve-year survival rate of 95% when used in an unselected, consecutive series of acetabular revisions. The rate of dislocation was significantly higher in the patients treated with isolated acetabular revision, and routine postoperative bracing is now recommended for that group.
关于在髋关节翻修术中使用非骨水泥髋臼组件的结果及并发症的长期随访报告较少。在本研究中，我们分析了临床和影像学结果，以确定影响钛纤维金属涂层髋臼组件长期生存率的因素。
在14年期间，一名外科医生对194例平均年龄为62岁的患者连续进行了211例未经选择的非骨水泥髋臼翻修术。所有翻修术均采用相同技术：将组件打入并用多枚螺钉固定，骨缺损处用补充骨移植进行加强。142髋同时进行了髋臼和股骨组件的翻修，而69髋仅进行了髋臼翻修。所有211例翻修术均纳入至12年的生存率分析。前瞻性确定的135髋的临床结果和131髋的影像学结果在术后至少5年时可得。
取出了7个髋臼组件：3个因感染，1个因反复脱位，3个因机械性松动。另有1个髋臼组件存在无症状的影像学松动，无菌性松动的总发生率为2%。12年假体生存率为95%（95%可信区间，91%至99%），失败定义为因任何原因取出组件。仅进行髋臼翻修的69髋与同时翻修两个组件的142髋之间，髋臼组件或股骨组件的生存率无显著差异。仅进行髋臼翻修的髋（14髋脱位，20%）与两个组件均已翻修的髋（11髋脱位，8%；p = 0.03）之间脱位率有显著差异，但发生脱位时组件生存率无差异。患者体重>82 kg与髋臼失败之间存在显著关联（p = 0.04）。
这种用多枚螺钉固定的钛纤维金属涂层半球形组件，在一系列未经选择的连续髋臼翻修术中使用时，12年生存率为95%。仅进行髋臼翻修的患者脱位率显著更高，目前建议该组患者术后常规使用支具。
