Park Myung-Sik, Yoon Sun-Jung, Lee Ju Rang
Department of Orthopaedic Surgery, Chonbuk National University Hospital, Chonbuk - Republic of Korea.
Hip Int. 2015 Jan-Feb;25(1):61-6. doi: 10.5301/hipint.5000191. Epub 2014 Sep 18.
Cementation of a polyethylene liner into the well-fixed shell is a convenient option for revision total hip arthroplasty. We retrospectively reviewed 45 patients who had liner cementation to investigate the risk factors which gave rise to major complications and reoperation. Patients were observed for a minimum of 7 years (range 7.8-14 years). Relevant risk factors (age, BMI, surgical approach, previous cup size and position, types of coated surface) were assessed with Cox regression analysis. The mean Harris Hip Score was improved from 62.5 (range 57-68) preoperatively to 87.1 (range 70-97). A total of 7 hips (15.5%) had acetabular component loosening that was treated with reoperation. Prevalence of acetabular component loosening was statistically significantly higher in hydroxyapatite-coated group (5 of 13) than in the Ti-coated group (2 of 32, p = 0.015). All recurrent dislocations occurred in patients treated with a posterior approach. Diameter of the previous metal shell of below 54 mm showed a lower 10-year survival rate than those greater than 54 mm in diameter. PE liner cementation in stable metal cup is a useful alternative option for carefully selected patients. Pre-existing HA-coated cups as well as small sized cups were indicative of poor outcomes.
在翻修全髋关节置换术中，将聚乙烯内衬固定到牢固的髋臼杯内是一种便捷的选择。我们回顾性分析了45例行内衬固定术的患者，以探究导致严重并发症和再次手术的危险因素。对患者进行了至少7年的观察（范围为7.8 - 14年）。采用Cox回归分析评估相关危险因素（年龄、体重指数、手术入路、既往髋臼杯尺寸和位置、涂层表面类型）。Harris髋关节评分均值从术前的62.5（范围57 - 68）提高到了87.1（范围70 - 97）。共有7例髋关节（15.5%）出现髋臼假体松动，均接受了再次手术治疗。羟基磷灰石涂层组髋臼假体松动的发生率（13例中有5例）在统计学上显著高于钛涂层组（32例中有2例，p = 0.015）。所有复发性脱位均发生在采用后入路治疗的患者中。既往金属髋臼杯直径小于54 mm的患者10年生存率低于直径大于54 mm的患者。对于精心挑选的患者，在稳定的金属髋臼杯中进行聚乙烯内衬固定是一种有用的替代选择。预先存在的羟基磷灰石涂层髋臼杯以及小尺寸髋臼杯提示预后不良。
