Pierrepont J W, Feyen H, Miles B P, Young D A, Baré J V, Shimmin A J
The University of Sydney, NSW 2006, Australia; Optimized Ortho, NSW, Australia.
Melbourne Orthopaedic Group, 33 The Avenue, Windsor, VIC 3181, Australia.
Bone Joint J. 2016 Jul;98-B(7):910-6. doi: 10.1302/0301-620X.98B7.37062.
Long-term clinical outcomes for ceramic-on-ceramic (CoC) bearings are encouraging. However, there is a risk of squeaking. Guidelines for the orientation of the acetabular component are defined from static imaging, but the position of the pelvis and thus the acetabular component during activities associated with edge-loading are likely to be very different from those measured when the patient is supine. We assessed the functional orientation of the acetabular component.
A total of 18 patients with reproducible squeaking in their CoC hips during deep flexion were investigated with a control group of 36 non-squeaking CoC hips. The two groups were matched for the type of implant, the orientation of the acetabular component when supine, the size of the femoral head, ligament laxity, maximum hip flexion and body mass index.
The mean functional anteversion of the acetabular component at the point when patients initiated rising from a seated position was significantly less in the squeaking group than in the control group, 8.1° (-10.5° to 36.0°) and 21.1° (-1.9° to 38.4°) respectively (p = 0.002).
The functional orientation of the acetabular component during activities associated with posterior edge-loading are different from those measured when supine due to patient-specific pelvic kinematics. Individuals with a large anterior pelvic tilt during deep flexion might be more susceptible to posterior edge-loading and squeaking as a consequence of a significant decrease in the functional anteversion of the acetabular component. Cite this article: Bone Joint J 2016;98-B:910-16.
陶瓷对陶瓷（CoC）关节轴承的长期临床疗效令人鼓舞。然而，存在吱吱作响的风险。髋臼组件的定向指南是根据静态成像定义的，但在与边缘负荷相关的活动期间骨盆的位置以及髋臼组件的位置可能与患者仰卧时测量的位置有很大不同。我们评估了髋臼组件的功能定向。
共有18例在深度屈曲时CoC髋关节出现可重复性吱吱声的患者接受了研究，对照组为36例无吱吱声的CoC髋关节。两组在植入物类型、仰卧时髋臼组件的定向、股骨头大小、韧带松弛度、最大髋关节屈曲度和体重指数方面进行了匹配。
在吱吱声组中，患者从坐位开始起身时髋臼组件的平均功能前倾角明显小于对照组，分别为8.1°（-10.5°至36.0°）和21.1°（-1.9°至38.4°）（p =0.002）。
由于患者特定的骨盆运动学，在与后边缘负荷相关的活动期间髋臼组件的功能定向与仰卧时测量的不同。在深度屈曲时骨盆前倾较大的个体可能更容易受到后边缘负荷的影响，并由于髋臼组件功能前倾角的显著降低而出现吱吱声。引用本文：《骨关节杂志》2016年；98-B：910 - 16。
