Harris Orthopaedic Laboratory, Department of Orthopedics, Massachusetts General Hospital, Boston, MA 02114-2696, USA.
Clin Orthop Relat Res. 2013 Jul;471(7):2052-9. doi: 10.1007/s11999-013-2941-7. Epub 2013 Mar 29.
The majority (86%) of THAs performed in the United States are uncemented. This may increase the revision burden if uncemented fixation is associated with a higher risk of revision than other approaches.
QUESTION/PURPOSES: We sought to investigate trends for use of uncemented fixation and to analyze age-stratified risk of revision comparing cemented, hybrid, and uncemented fixation as reported by national hip arthroplasty registries.
Data were extracted from the annual reports of seven national hip arthroplasty registries; we included all national registries for which annual reports were available in English or a Scandinavian language, if the registry had a history of more than 5 years of data collection.
Current use of uncemented fixation in primary THAs varies between 15% in Sweden and 82% in Canada. From 2006 to 2010 the registries of all countries reported overall increases in the use of uncemented fixation; Sweden reported the smallest absolute increase (from 10% to 15%), and Denmark reported the greatest absolute increase (from 47% to 68%). Looking only at the oldest age groups, use of uncemented fixation also was increasing during the period. In the oldest age group of each of the registries we surveyed (age older than 65 years for England-Wales; age older than 75 years in three registries), cemented fixation was associated with a lower risk of revision than was uncemented fixation.
Increasing use of uncemented fixation in THA is a worldwide phenomenon. This trend is paradoxic, given that registry data, which represent nationwide THA outcomes, suggest that cemented fixation in patients older than 75 years results in the lowest risk of revision.
Level II, systematic review. See Guidelines for Authors for a complete description of levels of evidence.
在美国进行的全髋关节置换术（THA）中，大多数（86%）采用非骨水泥固定。如果非骨水泥固定与更高的翻修风险相关，而其他方法的风险较低，那么这可能会增加翻修的负担。
问题/目的：我们旨在研究非骨水泥固定的使用趋势，并通过国家髋关节置换登记处报告的骨水泥固定、混合固定和非骨水泥固定的分析年龄分层的翻修风险，来分析不同固定方法的风险。
从七个国家髋关节置换登记处的年度报告中提取数据；我们纳入了所有有英语或斯堪的纳维亚语年度报告的国家登记处，如果该登记处有超过 5 年的数据收集历史。
在初次 THA 中，非骨水泥固定的当前使用率在瑞典为 15%，在加拿大为 82%。从 2006 年到 2010 年，所有国家的登记处都报告了非骨水泥固定使用率的总体增加；瑞典报告的绝对增加最小（从 10%增加到 15%），而丹麦报告的绝对增加最大（从 47%增加到 68%）。仅观察最年长的年龄组，在此期间非骨水泥固定的使用率也在增加。在所调查的每个登记处的最年长年龄组（英格兰-威尔士年龄大于 65 岁；三个登记处年龄大于 75 岁）中，骨水泥固定与较低的翻修风险相关，而非骨水泥固定则与较高的翻修风险相关。
THA 中非骨水泥固定的使用日益增加是一个全球性现象。这种趋势是矛盾的，因为登记处数据代表了全国范围内的 THA 结果，表明在 75 岁以上的患者中使用骨水泥固定会导致最低的翻修风险。
II 级，系统评价。有关证据水平的完整描述，请参见作者指南。
