Seyler Thorsten M, Bonutti Peter M, Shen Jianhua, Naughton Marybeth, Kester Mark
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 3:116-25. doi: 10.2106/JBJS.F.00775.
The results of total hip arthroplasty in patients with osteonecrosis of the femoral head are not always optimal. The use of alumina-on-alumina interfaces in young and active patients may decrease wear and lower the rate of aseptic loosening of the implant and appears to be an attractive alternative to the use of conventional cobalt-chromium-on-polyethylene bearings. The purpose of this study was to evaluate the safety and efficacy of the alumina-on-alumina bearing in patients with osteonecrosis and to compare this group of patients to a group of similarly treated patients with osteoarthritis and a group of patients who received conventional cobalt-chromium-on-polyethylene bearings.
Patients were selected from a United States Investigational Device Exemption multicenter prospective randomized clinical study that was initiated in 1996. Seventy patients with osteonecrosis of the femoral head (seventy-nine hips) received a cementless alumina-on-alumina bearing system and were directly matched to seventy-six patients with osteoarthritis of the hip (seventy-nine hips) who were managed with the same implant. Both groups were compared with twenty-five patients (twenty-six hips) with osteonecrosis and twenty-five patients (twenty-six hips) with osteoarthritis who were managed with a cementless cobalt-chromium-on-polyethylene bearing system. All patients received a cementless hydroxyapatite-coated femoral stem and were followed both clinically and radiographically.
The clinical outcomes for alumina-on-alumina bearings were similar for both osteonecrotic and osteoarthritic hips. The seven-year survival probability was 95.5% for the osteonecrotic hips and 89.4% for the osteoarthritic hips in the alumina-on-alumina bearing group and 92.3% for the osteonecrotic hips and 92.9% for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group. At the time of the most recent follow-up, the mean Harris hip score was 96 points for both the osteonecrotic and the osteoarthritic hips in the alumina-on-alumina group and 96 points for the osteonecrotic hips and 97 points for the osteoarthritic hips in the cobalt-chromium-on-polyethylene bearing group.
The results of the use of alumina-on-alumina and cobalt-chromium-on-polyethylene bearings in cementless standard total hip implants in patients with osteonecrosis and osteoarthritis were comparable. The low revision rate for the alumina-on-alumina bearing is encouraging and offers a promising option for younger, more active patients who have this challenging disease.
Therapeutic Level III. See Instructions to Authors on jbjs.org for a complete description of levels of evidence.
股骨头坏死患者全髋关节置换术的结果并非总是理想的。在年轻且活动量大的患者中使用氧化铝对氧化铝界面可能会减少磨损并降低植入物无菌性松动的发生率，似乎是使用传统钴铬对聚乙烯轴承的一种有吸引力的替代方案。本研究的目的是评估氧化铝对氧化铝轴承在股骨头坏死患者中的安全性和有效性，并将这组患者与一组接受类似治疗的骨关节炎患者以及一组接受传统钴铬对聚乙烯轴承的患者进行比较。
患者选自1996年启动的一项美国研究性器械豁免多中心前瞻性随机临床研究。70例股骨头坏死患者（79髋）接受了非骨水泥型氧化铝对氧化铝轴承系统，并与76例髋关节骨关节炎患者（79髋）直接匹配，后者使用相同的植入物进行治疗。将这两组患者与25例使用非骨水泥型钴铬对聚乙烯轴承系统治疗的股骨头坏死患者（26髋）和25例髋关节骨关节炎患者（26髋）进行比较。所有患者均接受了非骨水泥型羟基磷灰石涂层股骨柄，并进行了临床和影像学随访。
氧化铝对氧化铝轴承在股骨头坏死和骨关节炎髋关节中的临床结果相似。在氧化铝对氧化铝轴承组中，股骨头坏死髋关节的7年生存率为95.5%，骨关节炎髋关节为89.4%；在钴铬对聚乙烯轴承组中，股骨头坏死髋关节为92.3%，骨关节炎髋关节为92.9%。在最近一次随访时，氧化铝对氧化铝组中股骨头坏死和骨关节炎髋关节的平均Harris髋关节评分为96分，钴铬对聚乙烯轴承组中股骨头坏死髋关节为96分，骨关节炎髋关节为97分。
在股骨头坏死和骨关节炎患者的非骨水泥标准全髋关节植入物中使用氧化铝对氧化铝和钴铬对聚乙烯轴承的结果相当。氧化铝对氧化铝轴承的低翻修率令人鼓舞，为患有这种具有挑战性疾病的年轻、活动量大的患者提供了一个有前景的选择。
治疗性III级。有关证据水平的完整描述，请参阅jbjs.org上的作者须知。
