Petis Stephen M, Vasarhelyi Edward M, Lanting Brent A, Howard James L, Naudie Douglas D R, Somerville Lyndsay E, McCalden Richard W
From the Division of Orthopedic Surgery, London Health Sciences Centre, University Hospital, London, Ont.
Can J Surg. 2016 Feb;59(1):48-53. doi: 10.1503/cjs.010715.
The choice of bearing articulation for total hip arthroplasty in younger patients is amenable to debate. We compared mid-term patient-reported outcomes and survivorship across 2 different bearing articulations in a young patient cohort.
We reviewed patients with cobalt-chrome or oxidized zirconium on highly crosslinked polyethylene who were followed prospectively between 2004 and 2012. Kaplan-Meier analysis was used to determine predicted cumulative survivorship at 5 years with all-cause and aseptic revisions as the outcome. We compared patient-reported outcomes, including the Harris hip score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Short-form 12 (SF-12) scores.
A total of 622 patients were followed during the study period. Mean follow-up was 8.2 (range 2.0-10.6) years for cobalt-chrome and 7.8 (range 2.1-10.7) years for oxidized zirconium. Mean age was 54.9 ± 10.6 years for cobalt-chrome and 54.8 ± 10.7 years for oxidized zirconium. Implant survivorship was 96.0% (95% confidence interval [CI] 94.9%-97.1%) for cobalt-chrome and 98.7% (95% CI 98.0%-99.4%) for oxidized zirconium on highly crosslinked polyethylene for all-cause revisions, and 97.2% (95% CI 96.2%-98.2%) for cobalt-chrome and 99.0% (95% CI 98.4%-99.6%) for oxidized zirconium for aseptic revisions. An age-, sex- and diagnosis-matched comparison of the HHS, WOMAC and SF-12 scores demonstrated no significant changes in clinical outcomes across the groups.
Both bearing surface couples demonstrated excellent mid-term survivorship and outcomes in young patient cohorts. Future analyses on wear and costs are warranted to elicit differences between the groups at long-term follow-up.
年轻患者全髋关节置换术的关节面选择存在争议。我们比较了年轻患者队列中两种不同关节面的中期患者报告结局和假体生存率。
我们回顾了2004年至2012年间前瞻性随访的使用钴铬合金或氧化锆搭配高度交联聚乙烯的患者。采用Kaplan-Meier分析来确定以全因翻修和无菌翻修为结局的5年预测累积生存率。我们比较了患者报告的结局，包括Harris髋关节评分（HHS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）以及简明健康调查（SF-12）评分。
研究期间共随访了622例患者。钴铬合金组的平均随访时间为8.2年（范围2.0 - 10.6年），氧化锆组为7.8年（范围2.1 - 10.7年）。钴铬合金组的平均年龄为54.9±10.6岁，氧化锆组为54.8±10.7岁。对于全因翻修，钴铬合金搭配高度交联聚乙烯的假体生存率为96.0%（95%置信区间[CI] 94.9% - 97.1%），氧化锆为98.7%（95% CI 98.0% - 99.4%）；对于无菌翻修，钴铬合金为97.2%（95% CI 96.2% - 98.2%），氧化锆为99.0%（95% CI 98.4% - 99.6%）。对HHS、WOMAC和SF-12评分进行年龄、性别和诊断匹配的比较显示，各组间临床结局无显著变化。
两种关节面组合在年轻患者队列中均显示出优异的中期生存率和结局。有必要对磨损和成本进行未来分析，以揭示长期随访中两组之间的差异。
