Lübbeke A, Garavaglia G, Barea C, Stern R, Peter R, Hoffmeyer P
Division of Orthopaedic Surgery, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, CH-1211 Geneva, Switzerland.
J Bone Joint Surg Br. 2011 Apr;93(4):456-63. doi: 10.1302/0301-620X.93B4.25868.
We conducted a longitudinal study including patients with the same type of primary hybrid total hip replacement and evaluated patient activity and femoral osteolysis at either five or ten years post-operatively. Activity was measured using the University of California, Los Angeles scale. The primary outcome was the radiological assessment of femoral osteolysis. Secondary outcomes were revision of the femoral component for aseptic loosening and the patients' quality of life. Of 503 hip replacements in 433 patients with a mean age of 67.7 years (30 to 91), 241 (48%) were seen at five and 262 (52%) at ten years post-operatively. Osteolytic lesions were identified in nine of 166 total hip replacements (5.4%) in patients with low activity, 21 of 279 (7.5%) with moderate activity, and 14 of 58 (24.1%) patients with high activity. The risk of osteolysis increased with participation in a greater number of sporting activities. In multivariate logistic regression adjusting for age, gender, body mass index and the inclination angle of the acetabular component, the adjusted odds ratio for osteolysis comparing high vs moderate activity was 3.6 (95% confidence interval 1.6 to 8.3). Stratification for the cementing technique revealed that lower quality cementing increased the effect of high activity on osteolysis. Revision for aseptic loosening was most frequent with high activity. Patients with the highest activity had the best outcome and highest satisfaction. In conclusion, of patients engaged in high activity, 24% had developed femoral osteolysis five to ten years post-operatively.
我们开展了一项纵向研究，纳入接受相同类型初次混合式全髋关节置换术的患者，评估术后5年或10年时患者的活动情况及股骨骨溶解情况。使用加利福尼亚大学洛杉矶分校评分量表来衡量活动情况。主要结局是对股骨骨溶解进行影像学评估。次要结局是因无菌性松动而翻修股骨组件以及患者的生活质量。在433例平均年龄为67.7岁（30至91岁）的患者中进行了503例髋关节置换术，术后5年时对241例（48%）进行了随访，术后10年时对262例（52%）进行了随访。在活动量低的患者中，166例全髋关节置换术中有9例（5.4%）发现有溶骨病变；活动量中等的279例中有21例（7.5%）；活动量高的58例患者中有14例（24.1%）。参与的体育活动数量越多，发生骨溶解的风险越高。在对年龄、性别、体重指数和髋臼组件倾斜角度进行校正的多因素逻辑回归分析中，高活动量与中等活动量相比，骨溶解校正比值比为3.6（95%置信区间1.6至8.3）。根据骨水泥技术分层显示，骨水泥质量较差会增加高活动量对骨溶解的影响。因无菌性松动而翻修的情况在高活动量患者中最为常见。活动量最高的患者结局最佳且满意度最高。总之，在从事高活动量的患者中，24%在术后五至十年出现了股骨骨溶解。
