Mont Michael A, Seyler Thorsten M, Marker David R, Marulanda German A, Delanois Ronald E
Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:90-7. doi: 10.2106/JBJS.F.00543.
Recently, with the advent of improved metal-on-metal prostheses, total hip resurfacing has emerged as a viable arthroplasty option. However, it remains controversial whether this procedure should be used in patients with osteonecrosis when the femoral resurfacing component is cemented onto dead bone. The purpose of this study was to analyze the clinical and radiographic outcomes of metal-on-metal total hip resurfacing arthroplasty in patients with osteonecrosis of the femoral head. In addition, this group was compared with a matched group of patients who were diagnosed as having osteoarthritis.
Forty-two osteonecrotic hips that were treated with a metal-on-metal total hip resurfacing arthroplasty were studied. They were matched by gender, age, prosthesis, surgeon, and surgical approach to forty-two osteoarthritic hips that were treated with the same metal-on-metal prosthesis. In the osteonecrosis group, there were twenty-five men and eleven women, and in the osteoarthritis group, there were twenty-eight men and thirteen women. The mean age at the time of surgery was forty-two years. Patients were followed both clinically and radiographically for a mean of forty-one months.
The clinical outcomes were similar for both groups, with a good or excellent outcome in thirty-nine hips (93%) with osteonecrosis and a good or excellent outcome in forty-one hips (98%) with osteoarthritis. In each of the two groups, there were two failures that required conversion to a standard total hip arthroplasty. Survivorship curves were similar for the two patient groups.
The short-term results for metal-on-metal total hip resurfacing for this challenging patient population with osteonecrosis were excellent and comparable with those seen in patients with osteoarthritis. We await long-term results to see if these early results are maintained.
Prognostic Level II. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
近年来，随着金属对金属假体的改进，全髋关节表面置换术已成为一种可行的关节置换选择。然而，当股骨表面置换部件固定在坏死骨上时，该手术是否应用于股骨头坏死患者仍存在争议。本研究的目的是分析股骨头坏死患者行金属对金属全髋关节表面置换术的临床和影像学结果。此外，将该组患者与一组诊断为骨关节炎的匹配患者进行比较。
对42例行金属对金属全髋关节表面置换术治疗的坏死髋关节进行研究。根据性别、年龄、假体、外科医生和手术入路，将其与42例行相同金属对金属假体治疗的骨关节炎髋关节进行匹配。股骨头坏死组中，男性25例，女性11例；骨关节炎组中，男性28例，女性13例。手术时的平均年龄为42岁。对患者进行平均41个月的临床和影像学随访。
两组的临床结果相似，42例股骨头坏死患者中有39例（93%）结果为良好或优秀，42例骨关节炎患者中有41例（98%）结果为良好或优秀。两组各有2例失败病例，需要转换为标准全髋关节置换术。两组患者的生存率曲线相似。
对于这一具有挑战性的股骨头坏死患者群体，金属对金属全髋关节表面置换术的短期结果非常好，与骨关节炎患者的结果相当。我们期待长期结果，以观察这些早期结果是否能得以维持。
预后II级。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
