Research and Teaching Centre, Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, United Kingdom.
J Bone Joint Surg Am. 2010 Jan;92(1):105-12. doi: 10.2106/JBJS.I.00197.
Hip resurfacing has gained popularity for the treatment of young and active patients who have arthritis. Recent literature has demonstrated an increased rate of revision among female patients as compared with male patients who have undergone hip resurfacing. The aim of the present study was to identify any differences in survival or functional outcome between male and female patients with osteoarthritis who were managed with metal-on-metal hip resurfacing.
A prospective collection of data on all patients undergoing Birmingham Hip Resurfacing at a single institution was commenced in July 1997. On the basis of the inclusion and exclusion criteria, 1826 patients (2123 hips, including 799 hips in female patients and 1324 hips in male patients) with a diagnosis of osteoarthritis who had undergone the procedure between July 1997 and December 2008 were identified. The variables of age, sex, preoperative Oxford Hip Score, component size used, surgical approach, lead surgeon, and surgeon experience were analyzed. A multivariate Cox proportional hazard survival model was used to identify which variables were most influential for determining revision.
The mean duration of follow-up was 3.46 years (range, 0.03 to 10.9 years). The five-year cumulative survival rate for the 655 hips that were followed for a minimum of five years was 97.5% (95% confidence interval, 96.3% to 98.3%). There were forty-eight revisions. Revision was significantly associated with female sex (hazard rate, 2.03 [95% confidence interval, 1.15 to 3.58]; p = 0.014) and decreasing femoral component size (hazard rate per 4-mm decrease in size, 4.68 [95% confidence interval, 4.36 to 5.05]; p < 0.001). Revision was not associated with age (p = 0.88), surgeon (p = 0.41), surgeon experience (p = 0.30), or surgical approach (p = 0.21). A multivariate analysis including the covariates of sex, age, surgeon, surgeon experience, surgical approach, and femoral component size demonstrated that sex was no longer significantly associated with revision when femoral component size was included in the model (p = 0.37). Femoral component size alone was the best predictor of revision when all covariates were analyzed (hazard rate per 4-mm decrease in size, 4.87 [95% confidence interval, 4.37 to 5.42]; p < 0.001).
The present study demonstrates that although female patients initially may appear to have a greater risk of revision, this increased risk is related to differences in the femoral component size and thus is only indirectly related to sex. Patient selection for hip resurfacing is best made on the basis of femoral head size rather than sex.
髋关节表面置换术在治疗患有关节炎的年轻和活跃患者方面越来越受欢迎。最近的文献表明，与接受髋关节表面置换术的男性患者相比，女性患者的翻修率有所增加。本研究的目的是确定在接受金属对金属髋关节表面置换术治疗的骨关节炎男性和女性患者中，生存或功能结果是否存在差异。
1997 年 7 月开始在一家机构对所有接受伯明翰髋关节表面置换术的患者进行前瞻性数据收集。根据纳入和排除标准，确定了 1826 名（2123 髋，包括女性患者 799 髋，男性患者 1324 髋）患有骨关节炎且接受该手术的患者。分析了年龄、性别、术前牛津髋关节评分、使用的组件大小、手术入路、主刀医生和医生经验等变量。使用多变量 Cox 比例风险生存模型来确定哪些变量对确定翻修最有影响。
平均随访时间为 3.46 年（范围为 0.03 至 10.9 年）。随访至少 5 年的 655 髋的 5 年累积生存率为 97.5%（95%置信区间，96.3%至 98.3%）。有 48 例翻修。翻修与女性（危险率，2.03[95%置信区间，1.15 至 3.58]；p=0.014）和股骨组件尺寸减小（每减小 4mm 的危险率，4.68[95%置信区间，4.36 至 5.05]；p<0.001）显著相关。翻修与年龄（p=0.88）、医生（p=0.41）、医生经验（p=0.30）或手术入路（p=0.21）无关。包括性别、年龄、医生、医生经验、手术入路和股骨组件大小在内的多变量分析表明，当将股骨组件大小纳入模型时，性别与翻修不再显著相关（p=0.37）。当分析所有协变量时，股骨组件大小是翻修的最佳预测因素（每减小 4mm 的危险率，4.87[95%置信区间，4.37 至 5.42]；p<0.001）。
本研究表明，尽管女性患者最初似乎有更高的翻修风险，但这种风险增加与股骨组件尺寸的差异有关，因此仅与性别间接相关。髋关节表面置换术的患者选择最好基于股骨头大小，而不是性别。
