Lu Yu-Der, Yen Shih-Hsiang, Kuo Feng-Chih, Wang Jun-Wen, Wang Ching-Jen
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Biomed J. 2015 Dec;38(6):538-43. doi: 10.1016/j.bj.2016.01.005. Epub 2016 Mar 10.
Ceramic-on-ceramic (COC) total hip arthroplasty (THA) has gained popularity since improvements in wear characteristics and longevity. Whether large ceramic femoral heads (≥36 mm) have increased postoperative range of motion (ROM) and a lower dislocation rate is not clear. This study aimed to compare functional outcomes and early complications between large-head (≥36 mm) and smaller-head (≤32 mm) COC prostheses with a minimum follow-up of 12 months.
A total of 95 consecutive uncemented COC THAs were performed in 90 patients between January 2012 and July 2013. Of these, 49 patients (smaller-head group) received third generation and 41 patients (large-head group) received fourth generation COC prostheses. Harris hip score (HHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and ROM of the hip pre- and post-operatively were compared, as well as the presence of early complications.
Postoperative HHSs (88.4 vs. 89.3, p = 0.34) and WOMAC scores (12.0 vs. 11.0, p = 0.111) were not different between the groups. Postoperative flexion ROM was lower in the smaller-head group (98.8° vs. 106.1°, p < 0.001), but there were no differences in extension, abduction, adduction, internal rotation, and external rotation. One patient in each group reported a grinding noise. There was one dislocation (1.9%) in the smaller-head group, and none in the large-head group (p = 0.371). No infections or loosening of the components occurred.
Large-head COC articulation provided better flexion, but functional outcomes and early complications are similar to the smaller-head COC.
自磨损特性和使用寿命得到改善以来，陶瓷对陶瓷（COC）全髋关节置换术（THA）越来越受欢迎。大尺寸陶瓷股骨头（≥36毫米）是否能增加术后活动范围（ROM）并降低脱位率尚不清楚。本研究旨在比较大头（≥36毫米）和小头（≤32毫米）COC假体的功能结局和早期并发症，最短随访时间为12个月。
2012年1月至2013年7月期间，对90例患者连续进行了95例非骨水泥型COC THA手术。其中，49例患者（小头组）接受了第三代COC假体，41例患者（大头组）接受了第四代COC假体。比较了术前和术后的Harris髋关节评分（HHS）、西安大略和麦克马斯特大学关节炎指数（WOMAC）以及髋关节的ROM，以及早期并发症的发生情况。
两组术后HHS（88.4对89.3，p = 0.34）和WOMAC评分（12.0对11.0，p = 0.111）无差异。小头组术后屈曲ROM较低（98.8°对106.1°，p < 0.001），但在伸展、外展、内收、内旋和外旋方面无差异。每组各有1例患者报告有摩擦声。小头组有1例脱位（1.9%），大头组无脱位（p = 0.371）。未发生感染或假体松动。
大头COC关节提供了更好的屈曲，但功能结局和早期并发症与小头COC相似。
