National Joint Registry for England and Wales, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, UK.
Bone Joint J. 2013 Jun;95-B(6):747-57. doi: 10.1302/0301-620X.95B6.31378.
The popularity of cementless total hip replacement (THR) has surpassed cemented THR in England and Wales. This retrospective cohort study records survival time to revision following primary cementless THR with the most common combination (accounting for almost a third of all cementless THRs), and explores risk factors independently associated with failure, using data from the National Joint Registry for England and Wales. Patients with osteoarthritis who had a DePuy Corail/Pinnacle THR implanted between the establishment of the registry in 2003 and 31 December 2010 were included within analyses. There were 35 386 procedures. Cox proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. The overall rate of revision at five years was 2.4% (99% confidence interval 2.02 to 2.79). In the final adjusted model, we found that the risk of revision was significantly higher in patients receiving metal-on-metal (MoM: hazard ratio (HR) 1.93, p < 0.001) and ceramic-on-ceramic bearings (CoC: HR 1.55, p = 0.003) compared with the best performing bearing (metal-on-polyethylene). The risk of revision was also greater for smaller femoral stems (sizes 8 to 10: HR 1.82, p < 0.001) compared with mid-range sizes. In a secondary analysis of only patients where body mass index (BMI) data were available (n = 17 166), BMI ≥ 30 kg/m(2) significantly increased the risk of revision (HR 1.55, p = 0.002). The influence of the bearing on the risk of revision remained significant (MoM: HR 2.19, p < 0.001; CoC: HR 2.09, p = 0.001). The risk of revision was independent of age, gender, head size and offset, shell, liner and stem type, and surgeon characteristics. We found significant differences in failure between bearing surfaces and femoral stem size after adjustment for a range of covariates in a large cohort of single-brand cementless THRs. In this study of procedures performed since 2003, hard bearings had significantly higher rates of revision, but we found no evidence that head size had an effect. Patient characteristics, such as BMI and American Society of Anesthesiologists grade, also influence the survival of cementless components.
在英格兰和威尔士，骨水泥型全髋关节置换术（THR）的流行程度已经超过了骨水泥固定型 THR。本回顾性队列研究记录了在使用最常见组合（占所有非骨水泥 THR 的近三分之一）进行初次非骨水泥 THR 后，至翻修的生存时间，并利用英格兰和威尔士国家关节登记处的数据，探讨了与失败独立相关的风险因素。本研究纳入了在 2003 年登记处成立至 2010 年 12 月 31 日期间接受 Depuy Corail/Pinnacle THR 植入的骨关节炎患者。共纳入 35386 例手术。使用 Cox 比例风险模型分析了患者、外科医生和植入物协变量与翻修风险的关系。五年翻修率为 2.4%（99%置信区间为 2.02 至 2.79）。在最终调整模型中，我们发现与表现最佳的轴承（金属对聚乙烯）相比，使用金属对金属（MoM：风险比（HR）1.93，p<0.001）和陶瓷对陶瓷轴承（CoC：HR 1.55，p=0.003）的患者翻修风险显著更高。股骨柄较小（8 至 10 号：HR 1.82，p<0.001）的患者翻修风险也更高。在仅对 BMI 数据可用的患者（n=17166）的二次分析中，BMI≥30 kg/m2 显著增加了翻修风险（HR 1.55，p=0.002）。轴承对翻修风险的影响仍然显著（MoM：HR 2.19，p<0.001；CoC：HR 2.09，p=0.001）。在对大量单一品牌非骨水泥 THR 患者的一系列协变量进行调整后，我们发现不同轴承表面和股骨柄大小之间存在显著的失败差异。在这项对 2003 年以来进行的手术的研究中，硬轴承的翻修率明显更高，但我们没有发现头尺寸有影响的证据。患者特征，如 BMI 和美国麻醉医师协会分级，也会影响非骨水泥部件的存活率。
