Bouras T, Repantis T, Fennema P, Korovessis P
Orthopaedic Department, General Hospital Agios Andreas, Tsertidou 1, 26335 Patras, Greece.
Eur J Orthop Surg Traumatol. 2014 Dec;24(8):1439-45. doi: 10.1007/s00590-013-1314-y.
A recent comparative study reported lower revision rate and higher survival in ceramic-on-ceramic (CoC) than in metal-on-metal (MoM) coupling in Zweymüller-Plus THA. We retrospectively studied 87 consecutive patients (94 hips), who primarily received Zweymüller-Plus THA (SL-Plus stem, ceramic 28-mm ball head, Bicon cup) with third-generation CoC bearing surfaces for osteoarthritis. Survival, revision and osteolysis rate were studied and compared to those observed in historical series from this institution with the same THA and MoM articulation. The mean ± SD follow-up was 7.4 ± 1.7 years (range 6-10 years). Four hips (4%) in four patients were revised 1-6 years following primary implantation: one (1%) for aseptic loosening of SL-Plus stem and Bicon 5 years after index surgery; one (1%) for malpositioning of the Bicon and recurrent dislocations 1 year following implantation; and two (2%) for septic loosening 1 and 6 years postoperatively. Intraoperatively on inspection, there were neither findings for impingement in the revised hips, nor fracture of the Bicon ceramic inlay and ball head. Expansile osteolysis was shown around SL-Plus stem and Bicon in the revised for aseptic loosening hip. With revision of any component for aseptic loosening as the endpoint, the survival was 99% (95% CI 91-100%), while for revision for any reason, it was 95% (95% CI 87-98%) at 10 years. Zweymüller-Plus THA with CoC bearings showed, at mid-term follow-up, high survival and low revision rate for aseptic loosening. These rates were better than the historical series of the same THA with MoM articulation performed by the same surgeon.
Level IV.
最近一项比较研究报告称，在Zweymüller-Plus全髋关节置换术（THA）中，陶瓷对陶瓷（CoC）假体的翻修率低于金属对金属（MoM）假体，且生存率更高。我们回顾性研究了87例连续患者（94髋），这些患者最初接受Zweymüller-Plus THA（SL-Plus股骨柄、28毫米陶瓷球头、双锥杯），采用第三代CoC关节面治疗骨关节炎。研究了生存率、翻修率和骨溶解率，并与该机构此前采用相同THA和MoM关节的历史系列研究结果进行比较。平均随访时间为7.4±1.7年（范围6 - 10年）。4例患者的4髋（4%）在初次植入后1 - 6年进行了翻修：1髋（1%）是因为SL-Plus股骨柄和双锥杯在初次手术后5年出现无菌性松动；1髋（1%）是因为双锥杯位置不当和植入后1年反复脱位；2髋（2%）是因为术后1年和6年出现感染性松动。术中检查发现，翻修的髋关节均未发现撞击迹象，双锥陶瓷镶嵌物和球头也未发生骨折。在因无菌性松动而翻修的髋关节中，SL-Plus股骨柄和双锥周围出现了扩展性骨溶解。以因无菌性松动而翻修任何部件作为终点，10年时的生存率为99%（95%可信区间91 - 100%），而因任何原因进行翻修时，10年时的生存率为95%（95%可信区间87 - 98%）。中期随访显示，采用CoC关节面的Zweymüller-Plus THA生存率高，无菌性松动的翻修率低。这些比率优于同一位外科医生此前采用MoM关节的相同THA的历史系列研究结果。
IV级。
