金属对金属全髋关节表面置换术用于治疗股骨头缺血性坏死。

Use of metal-on-metal total hip resurfacing for the treatment of osteonecrosis of the femoral head.

作者信息

Mont Michael A, Seyler Thorsten M, Marker David R, Marulanda German A, Delanois Ronald E

机构信息

Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.

出版信息

J Bone Joint Surg Am. 2006 Nov;88 Suppl 3:90-7. doi: 10.2106/JBJS.F.00543.

DOI:10.2106/JBJS.F.00543

PMID:17079373

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.

摘要

背景

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。

方法

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。