Department of Orthopaedics and Traumatology, Turku University Central Hospital, Tampere, Finland.
Acta Orthop. 2011 Oct;82(5):521-9. doi: 10.3109/17453674.2011.618908.
In a previous study based on the Finnish Arthroplasty Register, the survival of cementless stems was better than that of cemented stems in younger patients. However, the survival of cementless cups was poor due to osteolysis. In the present study, we analyzed population-based survival rates of the cemented and cementless total hip replacements in patients under the age of 55 years with primary osteoarthritis in Finland.
3,668 implants fulfilled our inclusion criteria. The previous data included years 1980-2001, whereas the current study includes years 1987-2006. The implants were classified in 3 groups: (1) implants with a cementless, straight, proximally circumferentially porous-coated stem and a porous-coated press-fit cup (cementless group 1); (2) implants with a cementless, anatomic, proximally circumferentially porous-coated stem, with or without hydroxyapatite, and a porous-coated press-fit cup with or without hydroxyapatite (cementless group 2); and (3) a cemented stem combined with a cemented all-polyethylene cup (the cemented group). Analyses were performed separately for 2 time periods: those operated 1987-1996 and those operated 1997-2006.
The 15-year survival for any reason of cementless total hip replacement (THR) group 1 operated on 1987-1996 (62%; 95% CI: 57-67) and cementless group 2 (58%; CI: 52-66) operated on during the same time period was worse than that of cemented THRs (71%; CI: 62-80), although the difference was not statistically significant. The revision risk for aseptic loosening of cementless stem group 1 operated on 1987-1996 (0.49; CI: 0.32-0.74) was lower than that for aseptic loosening of cemented stems (p = 0.001).
Excessive wear of the polyethylene liner resulted in numerous revisions of modular cementless cups. The outcomes of total hip arthroplasty appear to have been relatively unsatisfactory for younger patients in Finland.
在之前基于芬兰关节置换登记库的一项研究中，与骨水泥固定型相比，非骨水泥固定型在年轻患者中的生存率更好。但是，由于骨溶解，非骨水泥固定型杯的生存率较差。在本研究中，我们分析了芬兰年龄在 55 岁以下原发性骨关节炎患者使用骨水泥固定型和非骨水泥固定型全髋关节置换的基于人群的生存率。
3668 个植入物符合我们的纳入标准。先前的数据包括 1980-2001 年，而当前的研究包括 1987-2006 年。这些植入物分为 3 组：（1）非骨水泥、直形、近端周向多孔涂层的柄和多孔涂层压配合杯（非骨水泥组 1）；（2）非骨水泥、解剖形、近端周向多孔涂层的柄，带或不带羟基磷灰石，以及带或不带羟基磷灰石的多孔涂层压配合杯（非骨水泥组 2）；和（3）骨水泥固定型柄与骨水泥固定型全聚乙烯杯（骨水泥固定型组）。分析分别针对两个时间段进行：1987-1996 年手术的患者和 1997-2006 年手术的患者。
1987-1996 年手术的非骨水泥全髋关节置换（THR）组 1（62%；95%CI：57-67）和同期手术的非骨水泥组 2（58%；CI：52-66）的任何原因的 15 年生存率均差于骨水泥 THR（71%；CI：62-80），尽管差异无统计学意义。1987-1996 年手术的非骨水泥组 1 中无菌性松动的翻修风险（0.49；CI：0.32-0.74）低于骨水泥固定型的无菌性松动（p=0.001）。
聚乙烯衬垫的过度磨损导致大量模块化非骨水泥杯需要翻修。芬兰年轻患者的全髋关节置换术结果似乎相对不理想。
