Services de chirurgie orthopédique et traumatologique 1 & 2, hôpital Trousseau, CHRU de Tours, Tours cedex 9, France.
Orthop Traumatol Surg Res. 2013 Jun;99(4 Suppl):S235-9. doi: 10.1016/j.otsr.2013.03.006. Epub 2013 Apr 28.
Cementless total hip arthroplasty (TKA) is gaining ground over cemented TKA. The objective of this study was to assess survival rates of a cemented THA implant (PF(®), Zimmer), after at least 10 years and to assess changes in acetabular bone structure.
Eighty-three ceramic-on-polyethylene THA prostheses were implanted between 1998 and 2001. Clinical outcomes were assessed using the Harris hip score and Postel Merle d'Aubigné score. For each hip, radiographs were examined for acetabular radiolucent lines, geodes, and granulomas; in addition, changes in bone structure and trabeculae were assessed comparatively to the other hip and classified from no change to severe osteolysis. Changes in trabeculae served to assess the loads applied to the bone. Polyethylene wear was assessed using the Livermore method.
A single patient was lost to follow-up. At last follow-up, 16 patients had died and six were contacted and had not required revision surgery; the remaining 52 patients (59 THAs) were re-evaluated and none had evidence of loosening. The Harris hip score at last evaluation was 91.6 compared to 60.5 preoperatively. No hips had evidence of acetabular osteolysis. For two hips, the radiographs showed complete acetabular radiolucent lines less than 2mm in width, with no mobilisation. Trabecular distribution was homogeneous with no stress shielding. Mean annual rate of wear was 0.08mm. No instances of femoral component loosening were recorded; granulomas involving no more than five Gruën zones were seen in three cases.
This study confirms the reliability of cemented THA, with a 12-year survival rate of 98.3%, in keeping with earlier data. Thus, our results establish that cemented ceramic-on-polyethylene prostheses remain valid options for THA.
IV.
非骨水泥全髋关节置换术（TKA）正在逐渐取代骨水泥 TKA。本研究的目的是评估至少 10 年后骨水泥 THR 植入物（PF（®），Zimmer）的生存率，并评估髋臼骨结构的变化。
1998 年至 2001 年间共植入 83 例陶瓷对聚乙烯 THR 假体。使用 Harris 髋关节评分和 Postel Merle d'Aubigné 评分评估临床结果。对每只髋关节进行髋臼射线透亮线、骨瘤和肉芽肿的放射学检查；此外，还比较了其他髋关节的骨结构和小梁的变化，并进行了从无变化到严重骨溶解的分类。小梁的变化用于评估施加在骨上的负荷。使用 Livermore 方法评估聚乙烯磨损。
有一名患者失访。最后一次随访时，16 名患者死亡，6 名患者联系不上且未接受翻修手术；其余 52 名患者（59 例 THR）接受了重新评估，均未发现松动迹象。最后一次评估时的 Harris 髋关节评分为 91.6，术前为 60.5。无髋臼骨溶解证据。有两个髋关节的射线照片显示完全髋臼射线透亮线，宽度小于 2mm，无活动。小梁分布均匀，无应力遮挡。平均年磨损率为 0.08mm。未记录到股骨组件松动的情况；有 3 例出现了累及不超过 5 个 Gruen 区的肉芽肿。
这项研究证实了骨水泥 THR 的可靠性，12 年生存率为 98.3%，与早期数据一致。因此，我们的结果表明，骨水泥陶瓷对聚乙烯假体仍然是 THR 的有效选择。
IV。
