Saragaglia D, Belvisi B, Rubens-Duval B, Pailhé R, Rouchy R C, Mader R
Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
Orthop Traumatol Surg Res. 2015 Jun;101(4):437-41. doi: 10.1016/j.otsr.2015.02.008. Epub 2015 Apr 18.
Large-diameter metal-on-metal hip prostheses are no longer used, but their outcomes after more than 5 years are unknown. We conducted a retrospective study with a 6.8-year mean follow-up to assess clinical outcomes after Durom™ cup implantation, including the dislocation rate, comparatively to the reference metal-on-polyethylene bearing. We determined the rate of failure ascribable to Durom™ cup use. We also looked for a sharp drop in the implant survival curve during the follow-up period and for factors associated with adverse reactions to metal debris (ARMDs).
We hypothesised that clinical outcomes after Durom™ cup implantation were similar to those seen with a metal-on-polyethylene bearing, except for a lower rate of dislocation.
We included 177 consecutive THA procedures that were performed between 2005 and 2008 in 165 patients with a mean age of 57.6 ± 9.4 years (range, 31-76 years) and involved the implantation of a Durom™ cup, a femoral head greater than 36mm in diameter, and a PF(®) femoral stem (Zimmer, Etupes, France). The mini-posterior approach was used, with 2mm of acetabular overreaming in 82% of cases, a short femoral neck in 75% of cases, and a mean cup inclination of 34 ± 5° (range, 21-50°).
Outcomes were assessed for 156 THA procedures in 146 patients after a mean follow-up of 6 years 8 months. The mean Postel-Merle d'Aubigné score improved from 9.7 ± 2.7 (range, 4-14) to 17.4 ± 1.7 (range, 15-18) and the mean Harris hip score from 45.2 ± 15.3 (range, 9-83) to 96.3 ± 7 (75-100). No episodes of dislocation were recorded. We identified 7 failures ascribable to the Durom™ cup including 6 due to ARMD and 1 to aseptic loosening. Implant survival after a mean of 80months was 95.5% (95% CI, 93.1-99.2), with no sharp drop in the survival curve.
The Durom™ cup eliminates the risk of hip dislocation and produces similar functional outcomes to those seen with metal-on-polyethylene bearings after a mean follow-up of 80 months. Nevertheless, given the difficulty in predicting ARMD and hypersensitivity reactions, the Durom™ cup has been discarded and patients carrying it are monitored closely.
大直径金属对金属髋关节假体已不再使用，但其5年以上的使用结果尚不清楚。我们进行了一项回顾性研究，平均随访6.8年，以评估Durom™髋臼杯植入后的临床结果，包括脱位率，并与参考金属对聚乙烯关节面进行比较。我们确定了因使用Durom™髋臼杯导致的失败率。我们还观察了随访期间植入物生存曲线的急剧下降情况以及与金属碎屑不良反应（ARMDs）相关的因素。
我们假设Durom™髋臼杯植入后的临床结果与金属对聚乙烯关节面相似，只是脱位率较低。
我们纳入了2005年至2008年间连续进行的177例全髋关节置换手术，患者共165例，平均年龄57.6±9.4岁（范围31 - 76岁），手术包括植入Durom™髋臼杯、直径大于36mm的股骨头以及PF(®)股骨柄（Zimmer，Etupes，法国）。采用微创后外侧入路，82%的病例髋臼扩大2mm，75%的病例股骨颈短缩，髋臼杯平均倾斜角度为34±5°（范围21 - 50°）。
对146例患者的156例全髋关节置换手术进行了平均6年8个月的随访后评估。Postel-Merle d'Aubigné平均评分从9.7±2.7（范围4 - 14）提高到17.4±1.7（范围15 - 18），Harris髋关节平均评分从45.2±15.3（范围9 - 83）提高到96.3±7（75 - 100）。未记录到脱位事件。我们确定了7例因Durom™髋臼杯导致的失败，其中6例是由于ARMD，1例是无菌性松动。平均80个月后的植入物生存率为95.5%（95%CI，93.1 - 99.2），生存曲线无急剧下降。
Durom™髋臼杯消除了髋关节脱位的风险，平均随访80个月后，其功能结果与金属对聚乙烯关节面相似。然而，鉴于难以预测ARMD和过敏反应，Durom™髋臼杯已被弃用，对携带该假体的患者进行密切监测。
