Wroblewski B Michael, Siney Paul D, Fleming Patricia A
The John Charnley Research Institute, Wrightington Hospital, Hall Lane, Appley Bridge, N Wigan, UK.
Acta Orthop. 2007 Apr;78(2):206-10. doi: 10.1080/17453670710013690.
In the early 1960s, Charnley was cautious with his patient selection for total hip replacement. As follow-up increased and confidence in the operation grew, younger patients were selected. We present our results of the Charnley LFA in young patients with rheumatoid and juvenile rheumatoid arthritis with a followup of up to 36 years.
We studied 292 Charnley low-friction arthroplasties in 195 young patients with an established diagnosis of rheumatoid arthritis. Their mean age at operation was 38 (12-50) years; 168 (58%) were receiving steroids and 79 (27%) were on non-steroidal antiinflammatory medication. The mean follow-up for the whole group was 15 (1-36) years. 24 patients could not be traced (33 hips), and 61 patients died (88 hips).
25 patients (41 hips) had had a revision. The main indication for revision was cup loosening. In the 85 patients (130 hips) attending follow-up, their mean age at surgery was 36 (17-50) years and the mean follow-up was 20 (10-36) years. 98% were pain-free or had no more than occasional discomfort, 44% claimed to have normal or near-normal function, while 62% had full or almost full range of movement of the replaced hip. Radiographically, 29 cups (22%) were considered to be loose. 1 stem (1%) was definitely loose and 2 stems (2%) were probably loose. With revision for any indication as the endpoint, the survival was 74% at 25 years follow-up.
The Charnley LFA continues to be an excellent hip replacement, even for very young rheumatoid arthritis patients. Wear and aseptic cup loosening are the main long-term problems.
20世纪60年代初，查恩利在全髋关节置换的患者选择上较为谨慎。随着随访时间的增加以及对该手术信心的增强，开始选择更年轻的患者。我们展示了对患有类风湿性关节炎和青少年类风湿性关节炎的年轻患者进行查恩利低摩擦全髋关节置换术的结果，随访时间长达36年。
我们研究了195例确诊为类风湿性关节炎的年轻患者的292例查恩利低摩擦人工关节置换术。他们手术时的平均年龄为38岁（12 - 50岁）；168例（58%）正在接受类固醇治疗，79例（27%）正在服用非甾体抗炎药。整个组的平均随访时间为15年（1 - 36年）。24例患者无法追踪到（33髋），61例患者死亡（88髋）。
25例患者（41髋）进行了翻修。翻修的主要指征是髋臼松动。在85例接受随访的患者（130髋）中，他们手术时的平均年龄为36岁（17 - 50岁），平均随访时间为20年（10 - 36年）。98%的患者无疼痛或仅有偶尔不适，44%的患者声称功能正常或接近正常，而62%的患者置换髋关节的活动范围完全或几乎完全正常。影像学检查显示，29个髋臼（22%）被认为松动。1个股骨柄（1%）肯定松动，2个股骨柄（2%）可能松动。以因任何指征进行翻修为终点，25年随访时的生存率为74%。
即使对于非常年轻的类风湿性关节炎患者，查恩利低摩擦全髋关节置换术仍然是一种出色的髋关节置换手术。磨损和无菌性髋臼松动是主要的长期问题。
