Haughom Bryan D, Erickson Brandon J, Hellman Michael D, Jacobs Joshua J
Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison Street, Suite 200, Chicago, IL, 60612, USA,
Clin Orthop Relat Res. 2015 Aug;473(8):2521-9. doi: 10.1007/s11999-015-4227-8.
Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender.
QUESTIONS/PURPOSES: This systematic review aimed to: (1) compare the rate of adverse local tissue reaction (ALTR); (2) dislocation; (3) aseptic loosening; and (4) revision between men and women undergoing primary MoM hip resurfacing arthroplasty (HRA).
Systematic MEDLINE and EMBASE searches identified all level I to III articles published in peer-reviewed journals, reporting on the outcomes of interest, for MoM HRA. Articles were limited to those with 2-year followup that reported outcomes by gender. Ten articles met inclusion criteria. Study quality was evaluated using the Modified Coleman Methodology Score; the overall quality was poor. Heterogeneity and bias were analyzed using a Mantel-Haenszel statistical method.
Women demonstrated an increased odds of developing ALTR (odds ratio [OR], 5.70 [2.71-11.98]; p<0.001), dislocation (OR, 3.04 [1.2-7.5], p=0.02), aseptic loosening (OR, 3.18 [2.21-4.58], p<0.001), and revision (OR, 2.50 [2.25-2.78], p<0.001) after primary MoM HRA.
A systematic review of the currently available literature reveals a higher rate of complications (ALTR, dislocation, aseptic loosening, and revision) after MoM HRA in women compared with men. Although femoral head size has been frequently implicated as a prime factor in the higher rate of complication in women, further research is necessary to specifically probe this relationship. Retrospective studies of data available (eg, registry data) should be undertaken, and moving forward studies should report outcomes by gender (particularly complications).
Level III, therapeutic study.
尽管金属对金属（MoM）关节面磨损率低且稳定性增加，但有证据表明某些MoM髋关节置换术并发症和失败率较高。一些证据表明，与男性相比，女性的失败率更高；然而，骨科文献整体上对按性别分层的此类并发症报道甚少。
问题/目的：本系统评价旨在：（1）比较初次MoM髋关节表面置换术（HRA）的男性和女性之间的局部组织不良反应（ALTR）发生率；（2）脱位发生率；（3）无菌性松动发生率；（4）翻修率。
通过对MEDLINE和EMBASE进行系统检索，确定了发表在同行评审期刊上的所有I至III级文章，这些文章报道了MoM HRA的相关结局。文章限于那些随访2年且按性别报告结局的研究。10篇文章符合纳入标准。采用改良科尔曼方法评分评估研究质量；总体质量较差。使用Mantel-Haenszel统计方法分析异质性和偏倚。
初次MoM HRA后，女性发生ALTR（优势比[OR]，5.70[2.71 - 11.98]；p<0.001）、脱位（OR，3.04[1.2 - 7.5]，p = 0.02）、无菌性松动（OR，3.18[2.21 - 4.58]，p<0.001）和翻修（OR，2.50[2.25 - 2.78]，p<0.001）的几率增加。
对现有文献的系统评价显示，与男性相比，女性在MoM HRA后并发症（ALTR、脱位、无菌性松动和翻修）发生率更高。尽管股骨头大小常被认为是女性并发症发生率较高的主要因素，但仍需进一步研究以明确探讨这种关系。应开展对现有数据（如登记数据）的回顾性研究，未来的研究应按性别报告结局（尤其是并发症）。
III级，治疗性研究。
