Münger Peter, Röder Christoph, Ackermann-Liebrich Ursula, Busato André
Maurice E. Müller Research Centre in Orthopaedic Surgery, University of Bern. Switzerland.
Acta Orthop. 2006 Aug;77(4):567-74. doi: 10.1080/17453670610012629.
We hypothesized that certain patient characteristics have different effects on the risk of early stem loosening in total hip arthroplasty (THA). We therefore conducted a case-control study using register-database records with the aim of identifying patient-specific risk factors associated with radiographic signs of aseptic loosening of the femoral component in THA.
Data were derived from a multinational European registry and were collected over a period of 25 years. 725 cases with radiographic signs of stem loosening were identified and matched to 4,310 controls without any signs of loosening. Matching criteria were type of implant, size of head, date of operation, center of primary intervention, and follow-up time. The risk factors analyzed were age at operation, sex, diagnosis and previous ipsilateral operations, height, weight, body mass index and mobility based on the Charnley classification.
Women showed significantly lower risk of radiographic loosening than men (odds ratio (OR) 0.64). Age was also a strong factor: risk decreased by 1.8% for each additional year of age at the time of surgery. Height and weight were not associated with risk of loosening. A higher body mass index, however, increased the risk of stem loosening to a significant extent (OR 1.03) per additional unit of BMI. Charnley Class B, indicating restricted mobility, was associated with lower risk of loosening (OR 0.78).
An increased activity level, as seen in younger patients and those with unrestricted mobility, is an important factor in the etiology of stem loosening. If combined with high BMI, the risk of stem loosening within 10 years is even higher. A younger person should not be denied the benefits of a total hip arthroplasty but must accept that the risk of future failure is increased.
我们假设某些患者特征对全髋关节置换术（THA）早期假体松动风险有不同影响。因此，我们利用登记数据库记录进行了一项病例对照研究，旨在确定与THA中股骨组件无菌性松动的影像学征象相关的患者特异性风险因素。
数据来源于一个欧洲多国登记处，收集时间长达25年。确定了725例有假体柄松动影像学征象的病例，并与4310例无任何松动征象的对照进行匹配。匹配标准为植入物类型、股骨头尺寸、手术日期、初次干预中心和随访时间。分析的风险因素包括手术年龄、性别、诊断及同侧既往手术史、身高、体重、体重指数以及基于Charnley分类的活动能力。
女性影像学松动风险显著低于男性（优势比（OR）0.64）。年龄也是一个重要因素：手术时每增加一岁，风险降低1.8%。身高和体重与松动风险无关。然而，体重指数每增加一个单位，假体柄松动风险会显著增加（OR 1.03）。Charnley B级表明活动受限，与较低的松动风险相关（OR 0.78）。
年轻患者及活动不受限者所表现出的活动水平增加是假体柄松动病因中的一个重要因素。若与高体重指数相结合，10年内假体柄松动风险更高。不应剥夺年轻人接受全髋关节置换术的益处，但他们必须接受未来失败风险增加这一事实。
