Sexton S A, Walter W L, Jackson M P, De Steiger R, Stanford T
Sydney Hip and Knee Surgeons, Mater Clinic, 3-9 Gillies Street, Sydney, NSW 2060, Australia.
J Bone Joint Surg Br. 2009 Nov;91(11):1448-53. doi: 10.1302/0301-620X.91B11.22100.
Dislocation is a common reason for revision following total hip replacement. This study investigated the relationship between the bearing surface and the risk of revision due to dislocation. It was based on 110 239 primary total hip replacements with a diagnosis of osteoarthritis collected by the Australian Orthopaedic Association National Joint Replacement Registry between September 1999 and December 2007. A total of 862 (0.78%) were revised because of dislocation. Ceramic-on-ceramic bearing surfaces had a lower risk of requiring revision due to dislocation than did metal-on-polyethylene and ceramic-on-polyethylene surfaces, with a follow-up of up to seven years. However, ceramic-on-ceramic implants were more likely to have larger prosthetic heads and to have been implanted in younger patients. The size of the head of the femoral component and age are known to be independent predictors of dislocation. Therefore, the outcomes were stratified by the size of the head and age. There is a significantly higher rate of revision for dislocation in ceramic-on-ceramic bearing surfaces than in metal-on-polyethylene implants when smaller sizes (< or = 28 mm) of the head were used in younger patients (< 65 years) (hazard ratio = 1.53, p = 0.041) and also with larger (> 28 mm) and in older patients (> or = 65 years) (hazard ratio = 1.73, p = 0.016).
脱位是全髋关节置换术后翻修的常见原因。本研究调查了关节面与脱位导致翻修风险之间的关系。该研究基于澳大利亚骨科协会国家关节置换登记处1999年9月至2007年12月收集的110239例诊断为骨关节炎的初次全髋关节置换病例。共有862例（0.78%）因脱位而进行了翻修。在长达七年的随访中，陶瓷对陶瓷关节面因脱位而需要翻修的风险低于金属对聚乙烯和陶瓷对聚乙烯关节面。然而，陶瓷对陶瓷植入物更有可能使用较大的假体头，并且植入的患者更年轻。已知股骨部件头的尺寸和年龄是脱位的独立预测因素。因此，根据头的尺寸和年龄对结果进行分层。当在年轻患者（<65岁）中使用较小尺寸（≤28mm）的头时，陶瓷对陶瓷关节面因脱位而翻修的发生率显著高于金属对聚乙烯植入物（风险比=1.53，p=0.041），在使用较大尺寸（>28mm）的头以及老年患者（≥65岁）中也是如此（风险比=1.73，p=0.016）。
