Jameson S S, Baker P N, Mason J, Porter M L, Deehan D J, Reed M R
School of Medicine and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, UK.
J Bone Joint Surg Br. 2012 Jun;94(6):746-54. doi: 10.1302/0301-620X.94B6.29239.
Modern metal-on-metal hip resurfacing has been widely performed in the United Kingdom for over a decade. However, the literature reports conflicting views of the benefits: excellent medium- to long-term results with some brands in specific subgroups, but high failure rates and local soft-tissue reactions in others. The National Joint Registry for England and Wales (NJR) has collected data on all hip resurfacings performed since 2003. This retrospective cohort study recorded survival time to revision from a resurfacing procedure, exploring risk factors independently associated with failure. All patients with a primary diagnosis of osteoarthritis who underwent resurfacing between 2003 and 2010 were included in the analyses. Cox's proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. A total of 27 971 hip resurfacings were performed during the study period, of which 1003 (3.59%) underwent revision surgery. In the final adjusted model, we found that women were at greater risk of revision than men (hazard ratio (HR) = 1.30, p = 0.007), but the risk of revision was independent of age. Of the implant-specific predictors, five brands had a significantly greater risk of revision than the Birmingham Hip Resurfacing (BHR) (ASR: HR = 2.82, p < 0.001, Conserve: HR = 2.03, p < 0.001, Cormet: HR = 1.43, p = 0.001, Durom: HR = 1.67, p < 0.001, Recap: HR = 1.58, p = 0.007). Smaller femoral head components were also significantly more likely to require revision (≤ 44 mm: HR = 2.14, p < 0.001, 45 to 47 mm: HR = 1.48, p = 0.001) than medium or large heads, as were operations performed by low-volume surgeons (HR = 1.36, p < 0.001). Once these influences had been removed, in 4873 male patients < 60 years old undergoing resurfacing with a BHR, the five-year estimated risk of revision was 1.59%. In summary, after adjustment for a range of covariates we found that there were significant differences in the rate of failure between brands and component sizes. Younger male patients had good five-year implant survival when the BHR was used.
现代金属对金属髋关节表面置换术在英国广泛开展已逾十年。然而，文献报道了关于其益处的相互矛盾的观点：某些品牌在特定亚组中取得了优异的中长期效果，但其他品牌则出现了高失败率和局部软组织反应。英格兰和威尔士国家关节注册中心（NJR）收集了自2003年以来所有髋关节表面置换术的数据。这项回顾性队列研究记录了表面置换手术至翻修的生存时间，探讨与失败独立相关的危险因素。所有在2003年至2010年间接受表面置换术且初步诊断为骨关节炎的患者均纳入分析。采用Cox比例风险模型分析翻修风险与患者、外科医生和植入物协变量之间的关联程度。研究期间共进行了27971例髋关节表面置换术，其中1003例（3.59%）接受了翻修手术。在最终调整模型中，我们发现女性翻修风险高于男性（风险比（HR）=1.30，p = 0.007），但翻修风险与年龄无关。在特定植入物预测因素中，五个品牌的翻修风险显著高于伯明翰髋关节表面置换术（BHR）（ASR：HR = 2.82，p < 0.001；Conserve：HR = 2.03，p < 0.001；Cormet：HR = 1.43，p = 0.001；Durom：HR = 1.67，p < 0.001；Recap：HR = 1.58，p = 0.007）。较小的股骨头组件也比中等或大尺寸的组件更显著地需要翻修（≤44mm：HR = 2.14，p < 0.001；45至47mm：HR = 1.48，p = 0.001），低手术量外科医生进行的手术也是如此（HR = 1.36，p < 0.001）。去除这些影响因素后，在4873例年龄<60岁接受BHR表面置换术的男性患者中，五年翻修估计风险为1.59%。总之，在对一系列协变量进行调整后，我们发现不同品牌和组件尺寸之间的失败率存在显著差异。使用BHR时，年轻男性患者的植入物五年生存率良好。
