Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143-0728, USA.
Clin Orthop Relat Res. 2010 Sep;468(9):2357-62. doi: 10.1007/s11999-010-1262-3.
To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown.
QUESTIONS/PURPOSES: We compared the short-term risk of complication and revision THA among Medicare patients having a primary THA with metal-polyethylene (M-PE), metal-metal (M-M), and ceramic-ceramic (C-C) bearings.
We used the 2005 to 2007 100% Medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of THA patients (M-PE, M-M, and C-C) who were matched by age, gender, and US census region. Multivariate Cox proportional-hazards models were constructed to compare complication and revision THA risk among cohorts, adjusting for medical comorbidities, race, socioeconomic status, and hospital factors.
After adjusting for patient and hospital factors, M-M bearings were associated with a higher risk of periprosthetic joint infection (hazard ratio, 3.03; confidence interval, 1.02-9.09) when compared with C-C bearings (0.59% versus 0.32%, respectively). There were no other differences among bearing cohorts in the adjusted risk of revision THA or any other complication.
The risk of short-term complication (including dislocation) and revision THA were similar among appropriately matched Medicare THA patients regardless of bearing surface. Hard-on-hard THA bearings are of questionable value in Medicare patients, given the higher cost associated with their use and uncertain long-term benefits in older patients.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
为了解决传统金属-聚乙烯（M-PE）全髋关节置换术（THA）中与磨损和骨溶解相关的长期问题，已引入金属-金属（M-M）和陶瓷-陶瓷（C-C）轴承。这些承载面具有独特的风险和益处，成本更高。但是，在老年人群中，这三种轴承的相对风险尚不清楚。
问题/目的：我们比较了在接受初次 M-PE、M-M 和 C-C 全髋关节置换术的 Medicare 患者中，短期内并发症和翻修 THA 的风险。
我们使用了 2005 年至 2007 年 100%的 Medicare 住院患者索赔文件，在三组分别接受 M-PE、M-M 和 C-C 全髋关节置换术的患者中进行了匹配队列分析，这些患者按年龄、性别和美国人口普查区域进行匹配。构建了多变量 Cox 比例风险模型，以比较队列之间并发症和翻修 THA 的风险，调整了医疗合并症、种族、社会经济地位和医院因素。
在调整了患者和医院因素后，与 C-C 轴承（分别为 0.59%和 0.32%）相比，M-M 轴承与假体周围关节感染的风险更高（风险比，3.03；置信区间，1.02-9.09）。在调整后的翻修 THA或任何其他并发症风险方面，各组之间没有其他差异。
在适当匹配的 Medicare THA 患者中，无论轴承表面如何，短期并发症（包括脱位）和翻修 THA 的风险相似。对于 Medicare 患者而言，硬对硬 THA 轴承的价值值得怀疑，因为其使用成本较高，而且在老年患者中的长期获益不确定。
二级，预后研究。有关证据水平的完整描述，请参见《作者指南》。
