Department of Orthopadic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Clin Orthop Relat Res. 2014 Feb;472(2):509-16. doi: 10.1007/s11999-013-3157-6.
Evidence suggests some metal-on-metal (MOM) THAs have higher rates of failure and subsequent revision than other bearing surfaces. However, there are few studies demonstrating how these patients fare after revision.
QUESTIONS/PURPOSES: We asked: (1) What is the short-term survivorship of revision THA in patients whose index THAs employed MOM bearings? (2) What are the causes of failure of revision THA in these patients (ie, what are the indications for repeat revision)? (3) What are the most common complications after revisions of MOM THAs?
We identified 37 patients (24 women, 13 men; mean age, 55 years; 37 hips) revised for aseptic failure of primary stemmed MOM THAs. Reasons for revision included pain with loose components (n = 19), adverse reaction to metal debris (n = 8), periprosthetic fracture (n = 4), impingement (n = 3), dislocation (n = 2), and pain of unknown origin (n = 1). Minimum followup was 24 months (mean, 33 months; range, 24-81 months) postrevision, but 11 were not seen in the last 2 years as our routine followup is at 2 and 5 years. Clinical histories were reviewed for reasons for failure of the MOM THAs and complications associated with revision surgery.
Survivorship free from further revision for any cause was 95% at 24 months and 92% at latest followup (24-81 months). There were three repeat revisions, all for periprosthetic infection, and all were treated with two-stage reimplantation. No other complications were observed.
We observed a higher-than-expected rate of infection after revision of MOM THAs. The infection rate was higher in this report than in an earlier series looking at revision THAs for other indications at our institution. As revision of MOM THA becomes more common, it will be important to continue monitoring postrevision outcomes and providing treatment strategies to mitigate complications for these patients.
有证据表明，一些金属对金属（MOM）髋关节置换术的失败率和随后的翻修率高于其他轴承表面。然而，很少有研究表明这些患者在翻修后的情况。
问题/目的：我们提出了以下问题：（1） 采用 MOM 轴承的初次全髋关节置换术（THA）患者行翻修 THA 的短期生存率如何？（2） 这些患者翻修 THA 的失败原因是什么（即，再次翻修的指征是什么）？（3） MOM THA 翻修后的常见并发症有哪些？
我们共纳入了 37 例（24 名女性，13 名男性；平均年龄 55 岁；37 髋）因初次使用 MOM 轴承的全髋关节置换术后无菌性失败而接受翻修的患者。翻修原因包括松动组件引起的疼痛（n = 19）、金属颗粒引起的不良反应（n = 8）、假体周围骨折（n = 4）、撞击（n = 3）、脱位（n = 2）和原因不明的疼痛（n = 1）。翻修后随访时间至少为 24 个月（平均 33 个月；范围，24-81 个月），但 11 例患者在过去 2 年中未进行随访，因为我们的常规随访时间为 2 年和 5 年。我们对 MOM THA 失败的原因和与翻修手术相关的并发症进行了回顾性分析。
翻修后无任何原因再次翻修的生存率在 24 个月时为 95%，在末次随访（24-81 个月）时为 92%。有 3 例患者再次翻修，均因假体周围感染，均采用二期再植入治疗。未观察到其他并发症。
我们观察到 MOM THA 翻修后感染率高于预期。与我们机构中其他指征的翻修 THA 相比，本研究中报告的感染率更高。随着 MOM THA 翻修的日益普及，继续监测翻修后的结果并为这些患者提供治疗策略以减轻并发症将非常重要。
