Orthopaedic Department, Roger Salengro Hospital, Centre Hospitalier Régional Universitaire de Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France.
J Bone Joint Surg Am. 2010 Oct 20;92(14):2419-26. doi: 10.2106/JBJS.I.01644.
Total hip arthroplasty in patients younger than thirty years of age represents a long-term challenge. As polyethylene wear secondary to a high activity level could be problematic, hard-on-hard bearings have been proposed to reduce wear. The aim of this retrospective case series was to assess the clinical and radiographic results of primary metal-on-metal total hip arthroplasty in patients thirty years of age or younger.
We retrospectively studied thirty-four patients (forty-seven hips) who had undergone metal-on-metal total hip arthroplasty and analyzed the radiographic and clinical measurements after a mean duration of follow-up of 108 months (range, 62.4 to 153.6 months). The mean age of the patients at the time of surgery was twenty-five years (range, fifteen to thirty years). The diameter of the head of the femoral component was 28 mm in all hips except five, in which it was 32 mm. The metal-on-metal bearing was the same in all patients.
The mean Merle d'Aubigné score increased from 10.6 (range, 1 to 14) to 17.1 (range, 12 to 18). No wear was found on the latest radiograph, but osteolysis was noted in three femora and two acetabula. Two revisions were performed, one because of impingement secondary to cup malorientation and the other because of acetabular loosening with osteolysis. Kaplan-Meier analysis with revision of either component as the end point revealed a ten-year survival rate of 94.5% (95% confidence interval, 80% to 98.6%). The survival rate of the femoral stem was 100%.
These encouraging intermediate-term results indicate that hip arthroplasty with metal-on-metal bearing components may be a suitable solution for young and active patients with hip osteoarthritis or osteonecrosis of the femoral head.
对于 30 岁以下的患者进行全髋关节置换术是一个长期的挑战。由于高活动水平导致的聚乙烯磨损可能会出现问题，因此提出了硬对硬轴承以减少磨损。本回顾性病例系列研究的目的是评估 30 岁或以下患者初次金属对金属全髋关节置换术的临床和影像学结果。
我们回顾性研究了 34 例（47 髋）接受金属对金属全髋关节置换术的患者，平均随访 108 个月（范围，62.4 至 153.6 个月）后分析了影像学和临床测量结果。手术时患者的平均年龄为 25 岁（范围，15 至 30 岁）。除 5 髋外，所有髋关节股骨组件头的直径均为 28mm，其余 5 髋为 32mm。所有患者的金属对金属轴承均相同。
平均 Merle d'Aubigné 评分从 10.6（范围，1 至 14）增加到 17.1（范围，12 至 18）。最新的 X 线片未见磨损，但在 3 个股骨和 2 个髋臼中发现了骨溶解。进行了 2 次翻修，一次是由于杯定向不良引起的撞击，另一次是由于髋臼松动伴骨溶解。以任何一种组件的翻修为终点的 Kaplan-Meier 分析显示 10 年生存率为 94.5%（95%置信区间，80%至 98.6%）。股骨柄的生存率为 100%。
这些令人鼓舞的中期结果表明，对于患有髋关节骨关节炎或股骨头坏死的年轻且活跃的患者，金属对金属轴承组件的髋关节置换术可能是一种合适的解决方案。
