金属对金属髋关节表面置换术后 10 年的生存率和血清离子浓度能否提供继续使用的证据？
Do survival rate and serum ion concentrations 10 years after metal-on-metal hip resurfacing provide evidence for continued use?
机构信息
Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Fetscherstr 74, 01307 Dresden, Germany.
出版信息
Clin Orthop Relat Res. 2012 Nov;470(11):3118-26. doi: 10.1007/s11999-012-2329-0.
BACKGROUND
Owing to concerns attributable to problems associated with metal-on-metal bearing surfaces, current evidence for the use of hip resurfacing is unclear. Survival rates reported from registries and individual studies are controversial and the limited long-term studies do not conclusively allow one to judge whether hip resurfacing is still a reasonable alternative to conventional THA.
QUESTIONS/PURPOSES: We asked whether the long-term survival rate of hip resurfacing is comparable to that of conventional THA and certain factors can be identified that influence serum ion concentration 10 years postoperatively. We specifically assessed (1) the 10-year survivorship in the whole cohort and in male and female patients, (2) serum concentrations of metal ions in patients with hip resurfacing who had not undergone revision surgery, and (3) potential influencing factors on the serum ion concentration.
METHODS
We retrospectively reviewed our first 95 patients who had 100 hip resurfacings performed from 1998 to 2001. The median age of the patients at surgery was 52 years (range, 28-69 years); 49% were men. We assessed the survival rate (revision for any reason as the end point), radiographic changes, and serum ion concentrations for cobalt, chromium, and molybdenum. The correlations between serum ion concentration and patient-related factors (age, sex, BMI, activity) and implant-related factors (implant size, cup inclination, stem-shaft angle) were investigated. The minimum followup was 9.3 years (mean, 10 years; range, 9.3-10.5 years).
RESULTS
The 10-year survivorship was 88% for the total cohort. The overall survival rate was greater in men (93%) than in women (84%). Median serum ion levels were 1.9 μg/L for chromium, 1.3 μg/L for cobalt, and 1.6 μg/L for molybdenum. Radiolucent lines around acetabular implants were observed in 4% and femoral neck thinning in 5%.
CONCLUSIONS
Although our overall failure rate was greater than anticipated, the relatively low serum ion levels and no revisions for pseudotumors in young male patients up to 10 years postoperatively provide some evidence of the suitability of hip resurfacing in this subgroup.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
背景
由于与金属对金属轴承表面相关问题的担忧，目前对于髋关节表面置换术的使用证据尚不清楚。来自注册处和个别研究的生存率报告存在争议，并且有限的长期研究不能明确判断髋关节表面置换术是否仍然是传统全髋关节置换术的合理替代方案。
问题/目的：我们想知道髋关节表面置换术的长期生存率是否与传统全髋关节置换术相当，以及是否可以确定 10 年后影响血清离子浓度的某些因素。我们特别评估了：（1）全队列以及男性和女性患者的 10 年生存率；（2）未行翻修手术的髋关节表面置换术患者的血清金属离子浓度；以及（3）血清离子浓度的潜在影响因素。
方法
我们回顾性分析了我们 1998 年至 2001 年间进行的 95 例 100 例髋关节表面置换术的首批患者。手术时患者的中位年龄为 52 岁（范围：28-69 岁）；49%为男性。我们评估了生存率（任何原因的翻修为终点）、影像学变化以及钴、铬和钼的血清离子浓度。研究了血清离子浓度与患者相关因素（年龄、性别、BMI、活动水平）和植入物相关因素（植入物大小、杯倾斜度、柄轴角度）之间的相关性。随访时间至少为 9.3 年（平均 10 年；范围：9.3-10.5 年）。
结果
全队列的 10 年生存率为 88%。男性（93%）的总体生存率高于女性（84%）。铬的中位血清离子水平为 1.9 μg/L，钴为 1.3 μg/L，钼为 1.6 μg/L。髋臼植入物周围观察到 4%的透光线，股骨颈变薄 5%。
结论
尽管我们的总体失败率高于预期，但在年轻男性患者中，10 年内血清离子水平相对较低且没有出现假性肿瘤的翻修为髋关节表面置换术在该亚组中的适用性提供了一些证据。
证据水平
IV 级，治疗性研究。请参阅作者说明以获取完整的证据水平描述。
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