Hôpital Maisonneuve - Rosemont, 5415 Boul L'Assomption, Montréal, Québec H1T 2M4, Canada.
Bone Joint J. 2013 Nov;95-B(11):1464-73. doi: 10.1302/0301-620X.95B11.31604.
A total of 219 hips in 192 patients aged between 18 and 65 years were randomised to 28-mm metal-on-metal uncemented total hip replacements (THRs, 107 hips) or hybrid hip resurfacing (HR, 112 hips). At a mean follow-up of eight years (6.6 to 9.3) there was no significant difference between the THR and HR groups regarding rate of revision (4.0% (4 of 99) vs 5.8% (6 of 104), p = 0.569) or re-operation rates without revision (5.1% (5 of 99) vs 2.9% (3 of 104), p = 0.428). In the THR group one recurrent dislocation, two late deep infections and one peri-prosthetic fracture required revision, whereas in the HR group five patients underwent revision for femoral head loosening and one for adverse reaction to metal debris. The mean University of California, Los Angeles activity scores were significantly higher in HR (7.5 (sd 1.7) vs 6.9 (sd 1.7), p = 0.035), but similar mean Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained (5.8 (sd 9.5) in HR vs 5.1 (sd 8.9) in THR, p = 0.615) at the last follow-up. Osteolysis was found in 30 of 81 THR patients (37.4%), mostly in the proximal femur, compared with two of 83 HR patients (2.4%) (p < 0.001). At five years the mean metal ion levels were < 2.5 μg/l for cobalt and chromium in both groups; only titanium was significantly higher in the HR group (p = 0.001). Although revision rates and functional scores were similar in both groups at mid-term, long-term survival analysis is necessary to determine whether one procedure is more advantageous than the other.
共有 192 名年龄在 18 至 65 岁之间的患者的 219 髋被随机分为 28 毫米金属对金属非骨水泥全髋关节置换术（THR，107 髋）或混合髋关节表面置换术（HR，112 髋）。平均随访 8 年（6.6 至 9.3 年）后，THR 组和 HR 组的翻修率（4.0%（4/99）与 5.8%（6/104），p=0.569）或无需翻修的再手术率（5.1%（5/99）与 2.9%（3/104），p=0.428）无显著差异。THR 组中 1 例复发性脱位、2 例晚期深部感染和 1 例假体周围骨折需要翻修，而 HR 组中 5 例患者因股骨头松动而行翻修，1 例因金属碎屑不良反应而行翻修。HR 组的加利福尼亚大学洛杉矶分校活动评分（7.5（sd 1.7））显著高于 THR 组（6.9（sd 1.7），p=0.035），但获得的西安大略省和麦克马斯特大学骨关节炎指数评分（HR 组 5.8（sd 9.5）与 THR 组 5.1（sd 8.9），p=0.615）相似。在最后一次随访时，81 例 THR 患者中有 30 例（37.4%）发现溶骨性病变，主要发生在股骨近端，而 83 例 HR 患者中有 2 例（2.4%）（p<0.001）。在 5 年时，两组钴和铬的金属离子水平均<2.5μg/l；只有 HR 组的钛明显更高（p=0.001）。虽然两组在中期的翻修率和功能评分相似，但需要进行长期生存分析以确定一种手术是否比另一种更有优势。
