Murray D W, Grammatopoulos G, Pandit H, Gundle R, Gill H S, McLardy-Smith P
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK.
J Bone Joint Surg Br. 2012 Sep;94(9):1180-6. doi: 10.1302/0301-620X.94B9.29462.
Recent events have highlighted the importance of implant design for survival and wear-related complications following metal-on-metal hip resurfacing arthroplasty. The mid-term survival of the most widely used implant, the Birmingham Hip Resurfacing (BHR), has been described by its designers. The aim of this study was to report the ten-year survival and patient-reported functional outcome of the BHR from an independent centre. In this cohort of 554 patients (646 BHRs) with a mean age of 51.9 years (16.5 to 81.5) followed for a mean of eight years (1 to 12), the survival and patient-reported functional outcome depended on gender and the size of the implant. In female hips (n = 267) the ten-year survival was 74% (95% confidence interval (CI) 83 to 91), the ten-year revision rate for pseudotumour was 7%, the mean Oxford hip score (OHS) was 43 (SD 8) and the mean UCLA activity score was 6.4 (SD 2). In male hips (n = 379) the ten-year survival was 95% (95% CI 92.0 to 97.4), the ten-year revision rate for pseudotumour was 1.7%, the mean OHS was 45 (SD 6) and the mean UCLA score was 7.6 (SD 2). In the most demanding subgroup, comprising male patients aged < 50 years treated for primary osteoarthritis, the survival was 99% (95% CI 97 to 100). This study supports the ongoing use of resurfacing in young active men, who are a subgroup of patients who tend to have problems with conventional THR. In contrast, the results in women have been poor and we do not recommend metal-on-metal resurfacing in women. Continuous follow-up is recommended because of the increasing incidence of pseudotumour with the passage of time.
近期事件凸显了金属对金属髋关节表面置换术后植入物设计对于假体存活及磨损相关并发症的重要性。其设计者已阐述了应用最为广泛的伯明翰髋关节表面置换术（BHR）的中期假体存活率。本研究旨在报告来自独立中心的BHR假体十年存活率及患者报告的功能结局。在这一队列的554例患者（646个BHR假体）中，平均年龄51.9岁（16.5至8l.5岁），平均随访时间8年（1至12年），假体存活率及患者报告的功能结局取决于性别及植入物尺寸。在女性髋关节（n = 267）中，十年存活率为74%（95%可信区间（CI）83至91），假瘤的十年翻修率为7%，牛津髋关节平均评分（OHS）为43（标准差8），加州大学洛杉矶分校（UCLA）活动评分平均为6.4（标准差2）。在男性髋关节（n = 379）中，十年存活率为95%（95%CI 92.0至97.4），假瘤的十年翻修率为1.7%，OHS平均为45（标准差6），UCLA平均评分为7.6（标准差2）。在要求最为苛刻的亚组，即年龄＜50岁的原发性骨关节炎男性患者中，存活率为99%（95%CI 97至100）。本研究支持继续对年轻活跃男性应用表面置换术，他们是一类在传统全髋关节置换术（THR）中往往会出现问题的患者亚组。相比之下，女性的结果较差，我们不建议对女性应用金属对金属表面置换术。鉴于假瘤的发生率随时间推移而增加，建议持续进行随访。
