Whittaker R K, Hothi H S, Meswania J M, Berber R, Blunn G W, Skinner J A, Hart A J
Institute of Orthopaedics and Musculoskeletal Science, University College London and London Implant Retrieval Centre (LIRC), Biomedical Engineering, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK.
Bone Joint J. 2016 Jul;98-B(7):917-24. doi: 10.1302/0301-620X.98B7.36554.
Surgeons have commonly used modular femoral heads and stems from different manufacturers, although this is not recommended by orthopaedic companies due to the different manufacturing processes. We compared the rate of corrosion and rate of wear at the trunnion/head taper junction in two groups of retrieved hips; those with mixed manufacturers (MM) and those from the same manufacturer (SM).
We identified 151 retrieved hips with large-diameter cobalt-chromium heads; 51 of two designs that had been paired with stems from different manufacturers (MM) and 100 of seven designs paired with stems from the same manufacturer (SM). We determined the severity of corrosion with the Goldberg corrosion score and the volume of material loss at the head/stem junction. We used multivariable statistical analysis to determine if there was a significant difference between the two groups.
We found no significant difference in the corrosion scores of the two groups. The median rate of material loss at the head/stem junction for the MM and SM groups were 0.39 mm(3)/year (0.00 to 4.73) and 0.46 mm(3)/year (0.00 to 6.71) respectively; this difference was not significant after controlling for confounding factors (p = 0.06).
The use of stems with heads of another manufacturer does not appear to affect the amount of metal lost from the surfaces between these two components at total hip arthroplasty. Other surgical, implant and patient factors should be considered when determining the mechanisms of failure of large diameter metal-on-metal hip arthroplasties. Cite this article: Bone Joint J 2016;98-B:917-24.
外科医生通常会使用不同制造商生产的模块化股骨头和股骨柄,尽管由于制造工艺不同,骨科公司并不推荐这样做。我们比较了两组翻修髋关节在耳轴/股骨头锥度连接处的腐蚀速率和磨损速率;一组是使用不同制造商产品组合的髋关节(MM组),另一组是使用同一制造商产品的髋关节(SM组)。
我们识别出151个翻修的大直径钴铬合金股骨头髋关节;其中51个髋关节的两种设计与不同制造商生产的股骨柄配对(MM组),100个髋关节的七种设计与同一制造商生产的股骨柄配对(SM组)。我们用戈德堡腐蚀评分法确定腐蚀的严重程度,并测定股骨头/股骨柄连接处的材料损失量。我们采用多变量统计分析来确定两组之间是否存在显著差异。
我们发现两组的腐蚀评分没有显著差异。MM组和SM组在股骨头/股骨柄连接处的材料损失中位数速率分别为每年0.39立方毫米(0.00至4.73)和每年0.46立方毫米(0.00至6.71);在控制混杂因素后,这种差异不显著(p = 0.06)。
在全髋关节置换术中,使用其他制造商生产的股骨头与股骨柄组合似乎不会影响这两个部件表面的金属损失量。在确定大直径金属对金属髋关节置换术的失败机制时,应考虑其他手术、植入物和患者因素。引用本文:《骨与关节杂志》2016年;98 - B:917 - 24。