Joint Implant Surgeons, Inc., New Albany, Ohio 43054, USA.
J Arthroplasty. 2011 Sep;26(6 Suppl):8-13. doi: 10.1016/j.arth.2011.04.029. Epub 2011 Jul 1.
Major weaknesses of total hip arthroplasty (THA) in the 20th century were polyethylene wear and dislocation. Efforts to improve THA took several directions including improvement of polyethylene and use of metal-on-metal (MoM) articulations. Metal-on-metal articulations showed excellent early results, but concerns mount over hypersensitivity and increasing failure. This study compares our experience with MoM and metal-on-improved polyethylene (MoIP) bearings in primary THA. We identified 1362 patients undergoing 1589 MoM THA and 693 patients undergoing 779 MoIP THA (all compression molded and sterilized in argon). Overall, more MoM than MoIP cups have been revised (4.0% vs 2.2%; P = .0241). Revision incidence for infection was similar; higher with MoM for loosening (P = .0020), metal complication (P = .0017), and combined aseptic causes (P = .0067); and higher for dislocation in MoIP (P = .0246). Metal-on-improved polyethylene devices had superior results compared with MoM in this study. Furthermore, 5 MoIP revisions were liner exchanges, a conservative option not available with MoM.
20 世纪全髋关节置换术（THA）的主要弱点是聚乙烯磨损和脱位。为了改善 THA，人们进行了多方面的努力，包括改进聚乙烯和使用金属对金属（MoM）关节。金属对金属关节在早期表现出了优异的效果，但人们越来越担心其超敏反应和不断增加的失败率。本研究比较了我们在初次 THA 中使用 MoM 和金属对改良聚乙烯（MoIP）轴承的经验。我们确定了 1362 例接受 1589 例 MoM THA 和 693 例接受 779 例 MoIP THA（均为压缩模制并在氩气中消毒）的患者。总体而言，MoM 杯的翻修率高于 MoIP（4.0%比 2.2%；P =.0241）。感染的翻修发生率相似；MoM 的松动（P =.0020）、金属并发症（P =.0017）和联合无菌原因（P =.0067）发生率较高，MoIP 的脱位发生率较高（P =.0246）。在这项研究中，与 MoM 相比，MoIP 装置的结果更优。此外，5 例 MoIP 翻修是衬垫更换，这是 MoM 无法采用的保守选择。
