Buttaro Martin A, Zanotti Gerardo, Comba Fernando M, Piccaluga Francisco
The Hip Surgery Unit, Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
J Arthroplasty. 2017 Feb;32(2):480-486. doi: 10.1016/j.arth.2016.07.032. Epub 2016 Aug 10.
Delta ceramics may be the bearing of choice for younger and active patients due to its improved toughness and wear characteristics, provided there is no risk of fracture. However, ceramic fracture is the most serious complication related to this type of bearing. Although millions of Delta ceramics have been implanted worldwide, short to midterm results have been scarcely reported in the literature. The purpose of this study was to report the complication rate at short to midterm follow-up associated with the bearing surface used in a series of primary total hip arthroplasties with Delta ceramic-on-ceramic bearings performed in a single institution.
A total of 939 cases (880 patients) undergoing primary total hip arthroplasty with fourth-generation Delta ceramic-on-ceramic bearings were retrospectively reviewed. They were followed for an average of 5.3 years (2-10 years).
One hip experienced a liner fracture, 2 cups presented early loosening due to friction between the acetabular screw and the backside of the liner, one femoral ball head had a fracture; one case of squeaking was reported, which is impending revision. Considering revision or impending revision in relationship with the bearing surface as the end point, the mean survival rate was 99.3% (confidence interval 95%, 98.3%-99.7%) at 2-10 years.
This study showed a low rate of ceramic fracture compared with others; however, it was much higher than the complication rate presented by the manufacturers. The complications observed were directly related to technical errors that surgeons should avoid when using this type of surface.
对于年轻且活跃的患者而言，Delta 陶瓷可能是理想的关节轴承，因为其韧性和耐磨特性更佳，前提是不存在骨折风险。然而，陶瓷骨折是与这类轴承相关的最严重并发症。尽管全球已植入数百万个 Delta 陶瓷，但文献中鲜有关于其短期至中期结果的报道。本研究旨在报告在单一机构进行的一系列采用 Delta 陶瓷对陶瓷轴承的初次全髋关节置换术中，短期至中期随访时与轴承表面相关的并发症发生率。
回顾性分析了总共 939 例（880 名患者）接受第四代 Delta 陶瓷对陶瓷轴承初次全髋关节置换术的病例。平均随访时间为 5.3 年（2 - 10 年）。
1 例髋关节出现内衬骨折，2 个髋臼杯因髋臼螺钉与内衬背面之间的摩擦而早期松动，1 个股骨头球头发生骨折；报告了 1 例有异响的病例，即将进行翻修。以与轴承表面相关的翻修或即将翻修作为终点，2 - 10 年时的平均生存率为 99.3%（95%置信区间，98.3% - 99.7%）。
本研究显示与其他研究相比陶瓷骨折发生率较低；然而，这一发生率远高于制造商公布的并发症发生率。观察到的并发症与技术失误直接相关，外科医生在使用这类表面时应避免这些失误。
