Röhrl Stephan M, Nivbrant Bosse, Ström Håkan, Nilsson Kjell G
Department of Surgery and Perioperative Science, Umed University Hospital, Umeå, Sweden.
J Arthroplasty. 2004 Dec;19(8):962-71. doi: 10.1016/j.arth.2004.06.024.
To evaluate different modes of cementless fixation of hemispherical cups, we operated on 87 hips in 81 patients using 4 different means of cup fixation. The hips were randomly assigned to fixation with press-fit technique only (PF), or with augmentation with screws (S), pegs (P), or hydroxyapatite (HA) coating. The patients were evaluated with radiostereometric analysis (RSA) for cup migration and wear, conventional radiography for osteolysis, and Harris Hip Score for clinical outcome over 5 years. The fixation of the cups did not differ between the groups, but HA showed a tendency to decrease proximal migration. HA-coated cups displayed the best interface with hardly any signs of radiolucent lines, indicating a superior sealing effect of the HA coating. Cups with screws or pegs had more radiolucent lines and osteolytic lesions than the other groups. Radiolucent lines were correlated to higher proximal migration, young age, and female gender (r2=.2). The wear rate of the ethylene oxide-sterilized polyethylene liner was high (0.2 mm/y) but did not differ between the groups. Two cups with a perioperative fracture of the acetabular rim showed large initial migration but stabilized thereafter.
为评估半球形髋臼杯非骨水泥固定的不同方式，我们采用4种不同的髋臼杯固定方法，对81例患者的87髋进行了手术。这些髋关节被随机分配为仅采用压配技术固定（PF），或采用螺钉（S）、骨栓（P）或羟基磷灰石（HA）涂层增强固定。通过放射立体测量分析（RSA）评估患者髋臼杯的移位和磨损情况，通过传统X线摄影评估骨溶解情况，并通过Harris髋关节评分评估5年的临床结局。各组之间髋臼杯的固定情况无差异，但HA显示出近端移位减少的趋势。HA涂层髋臼杯显示出最佳的界面，几乎没有透光线的迹象，表明HA涂层具有优异的密封效果。带螺钉或骨栓的髋臼杯比其他组有更多的透光线和骨溶解病变。透光线与更高的近端移位、年轻和女性性别相关（r2 = 0.2）。环氧乙烷灭菌的聚乙烯内衬磨损率较高（0.2 mm/年），但各组之间无差异。2例髋臼缘围手术期骨折的髋臼杯显示出较大的初始移位，但随后稳定。
