Restrepo Camilo, Ghanem Elie, Houssock Carrie, Austin Mathew, Parvizi Javad, Hozack William J
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2009 Jan;467(1):194-8. doi: 10.1007/s11999-008-0533-8. Epub 2008 Oct 10.
Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis. Thirty-six hips had isolated polyethylene exchange, while 31 had full acetabular revision. The minimum followup was 2 years (mean, 2.8 years; range, 2-5 years). Three of 36 hips with a retained cup grafted through the cup holes failed within 5 years due to acetabular loosening. One of 31 hips with full revision underwent re-revision for aseptic cup loosening at 5 months postoperatively. Although we do not recommend prophylactic revision of all cups for polywear and osteolysis, the patient may be warned of the possibility of an approximate 10% failure rate when retaining the acetabular component. We do, however, advocate cup extraction in the following situations: damage to the locking mechanism, erosion of the femoral head through the liner and into the cup damaging the metal, and a malpositioned component that may jeopardize the stability of the revision.
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
在全髋关节置换术（THA）的中长期随访中，聚乙烯磨损和骨溶解并不少见。对于无症状的患者，骨科医生面临的两难境地是，是翻修髋臼并冒着损伤支撑柱甚至骨盆连续性的风险，还是仅进行聚乙烯衬垫置换并冒着术后复发性不稳定和脱位发生率高的风险，而这可能需要进一步手术。我们回顾性分析了62例（67髋）因聚乙烯磨损和骨溶解而接受翻修关节成形术的患者。36髋仅进行了聚乙烯衬垫置换，而31髋进行了全髋臼翻修。最短随访时间为2年（平均2.8年；范围2 - 5年）。36例保留髋臼并通过髋臼孔植骨的患者中有3例在5年内因髋臼松动而失败。31例全翻修患者中有1例在术后5个月因无菌性髋臼松动而再次翻修。虽然我们不建议对所有因聚乙烯磨损和骨溶解的髋臼进行预防性翻修，但应告知患者保留髋臼组件时可能有大约10%的失败率。然而，我们确实主张在以下情况下取出髋臼组件：锁定机制受损、股骨头通过衬垫侵蚀进入髋臼并损坏金属、以及组件位置不当可能危及翻修稳定性。
II级，预后研究。有关证据水平的完整描述，请参阅作者指南。
