Vendittoli Pascal-André, Rivière Charles, Lavigne Martin, Lavoie Pauline, Alghamdi Ahmed, Duval Nicolas
From the Montreal University Hospital, and the Maisonneuve-Rosemont Hospital, Montréal, Québec.
Acta Orthop Belg. 2013 Apr;79(2):181-90.
We report the long-term results of a randomized clinical trial that compares, in total hip arthroplasty in a young population, metal-on-conventional polyethylene and alumina-on-alumina ceramic bearings. One hundred and forty hips in 116 patients were randomized. Re-operation, revision rate, clinical scores, and radiological signs of osteolysis and loosening were compared at average follow-up of 123 (9-15) years. At final FU, 107 hips were available for clinical evaluation. Eight (11.6%) revisions were performed in the polyethylene group versus 1 (1.4%) in the ceramic group (p = 0.017). All revisions in the polyethylene group were related to bearing wear: 4 for aseptic loosening with severe osteolysis, 1 for polyethylene induced compressive granulomatous tumor, and 3 for severe liner wear. The only revised case from the ceramic group was secondary to mechanical stem loosening. Mean annual polyethylene wear was 0.19mm/year; wear was not measurable in the ceramic group. Our study confirms, in the long-term, the superiority of ceramic-on-ceramic pairing in comparison to metal-on-conventional polyethylene and supports their use in young, active patients.
我们报告了一项随机临床试验的长期结果，该试验比较了年轻人群全髋关节置换术中金属对传统聚乙烯和氧化铝对氧化铝陶瓷轴承的效果。116例患者的140个髋关节被随机分组。在平均123（9 - 15）年的随访中，比较了再次手术、翻修率、临床评分以及骨溶解和松动的放射学征象。在最终随访时，107个髋关节可进行临床评估。聚乙烯组进行了8例（11.6%）翻修，而陶瓷组为1例（1.4%）（p = 0.017）。聚乙烯组的所有翻修均与轴承磨损有关：4例因无菌性松动伴严重骨溶解，1例因聚乙烯诱导的压缩性肉芽肿肿瘤，3例因严重衬垫磨损。陶瓷组唯一的翻修病例继发于机械性柄松动。聚乙烯的年均磨损为0.19毫米/年；陶瓷组的磨损无法测量。我们的研究长期证实，与金属对传统聚乙烯相比，陶瓷对陶瓷配对具有优越性，并支持在年轻、活跃的患者中使用。
