Hanna S A, Somerville L, McCalden R W, Naudie D D, MacDonald S J
University of Western Ontario, London, Ontario, N6G 2V4, Canada.
Bone Joint J. 2016 Jan;98-B(1):28-32. doi: 10.1302/0301-620X.98B1.36527.
The purpose of this study was to compare the long-term results of primary total hip arthroplasty (THA) in young patients using either a conventional (CPE) or a highly cross-linked (HXLPE) polyethylene liner in terms of functional outcome, incidence of osteolysis, radiological wear and rate of revision.
We included all patients between the ages of 45 and 65 years who, between January 2000 and December 2001, had undergone a primary THA for osteoarthritis at our hospital using a CPE or HXLPE acetabular liner and a 28 mm cobalt-chrome femoral head. From a total of 160 patients, 158 (177 hips) were available for review (CPE 89; XLPE 88). The mean age, body mass index (BMI) and follow-up in each group were: CPE: 56.8 years (46 to 65); 30.7 kg/m(2) (19 to 58); 13.2 years (2.1 to 14.7) and HXLPE: 55.6 years (45 to 65); BMI: 30 kg/m(2) (18 to 51); 13.1 years (5.7 to 14.4).
The mean Harris hip score (HHS) at final follow-up was 89.3 for the CPE group and 90.9 for the HXLPE group (p = 0.078). Osteolysis was present around 15 acetabular (17%) and 16 femoral (18%) components in the CPE hips compared with none (0%) in the HXLPE hips. The mean radiological linear wear of the CPE liners was 0.11 mm/year compared with 0.035 mm/year for the HXLPE liners (p = 0.006). The cumulative implant survival, with revision for polyethylene wear as the endpoint, was 86% (95% confidence interval 78 to 94) in the CPE group and 100% in the HXLPE group at 13 years (numbers at risk at 13 years - CPE: 65, XLPE: 61).
This study shows that HXLPE liners are associated with significantly less osteolysis and a lower rate of revision THA than CPE liners at long-term follow-up.
The findings of this study highlight the clinical benefits of using HXLPE liners in THA and support the routine use of the material in order to improve implant longevity and to decrease the number of patients needing revision for aseptic osteolysis.
本研究旨在比较在年轻患者中采用传统聚乙烯（CPE）内衬或高交联聚乙烯（HXLPE）内衬进行初次全髋关节置换术（THA）的长期结果，包括功能结局、骨溶解发生率、影像学磨损及翻修率。
我们纳入了2000年1月至2001年12月期间在我院因骨关节炎接受初次THA的所有45至65岁患者，这些患者使用了CPE或HXLPE髋臼内衬及28毫米钴铬合金股骨头。在总共160例患者中，158例（177髋）可供评估（CPE组89例；XLPE组88例）。每组的平均年龄、体重指数（BMI）及随访时间分别为：CPE组：56.8岁（46至65岁）；30.7kg/m²（19至58）；13.2年（2.1至14.7年）；HXLPE组：55.6岁（45至65岁）；BMI：30kg/m²（18至51）；13.1年（5.7至14.4年）。
末次随访时，CPE组的平均Harris髋关节评分（HHS）为89.3分，HXLPE组为90.9分（p = 0.078）。CPE内衬髋关节周围有15个髋臼组件（17%）和16个股骨组件（18%）出现骨溶解，而HXLPE内衬髋关节无一例（0%）出现骨溶解。CPE内衬的平均影像学线性磨损为每年0.11毫米，而HXLPE内衬为每年0.035毫米（p = 0.006）。以聚乙烯磨损翻修为终点的累积植入物生存率，CPE组在13年时为86%（95%置信区间78%至94%），HXLPE组为100%（13年时的风险例数 - CPE组：65例，XLPE组：61例）。
本研究表明，在长期随访中，与CPE内衬相比，HXLPE内衬与明显更少的骨溶解及更低的THA翻修率相关。
本研究结果突出了在THA中使用HXLPE内衬的临床益处，并支持常规使用该材料以提高植入物使用寿命并减少因无菌性骨溶解需要翻修的患者数量。
