Shah Siddharth M, Walter William L, Tai Stephen M, Lorimer Michelle F, de Steiger Richard N
Specialist Orthopaedic Group, Wollstonecraft, New South Wales, Australia.
Department of Clinical Research, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
J Arthroplasty. 2017 Sep;32(9):2852-2856. doi: 10.1016/j.arth.2017.04.037. Epub 2017 Apr 27.
Dislocation is a leading cause of revision after primary total hip arthroplasty (THA). Although more common in the first few years after the procedure, dislocation can occur at any time. This study investigated the difference in late dislocation in ceramic-on-ceramic (CoC) bearings compared with metal-on-polyethylene and ceramic-on-polyethylene bearings in THA.
Data were used from the Australian Orthopaedic Association National Joint Replacement Registry, and the cumulative percent revision for dislocation was estimated using the Kaplan-Meier method for the different bearing surfaces. There were 192,275 THAs included in the study with 101,915 metal-on-cross-linked polyethylene (MoXLPE), 30,256 ceramic-on-cross-linked polyethylene (CoXLPE), and 60,104 CoC.
The cumulative percent revision for dislocation at 13 years for MoXLPE, CoXLPE, and CoC groups was 1.2 (95% confidence interval [CI], 1.1-1.3), 1.0 (95% CI, 0.7-1.4), and 0.9 (95% CI, 0.8-1.1), respectively. There was an increased risk of revision for dislocation for MoXLPE compared with CoXLPE and CoC. When stratified for head size, there was no difference in the risk of revision for dislocation between MoXLPE, CoXLPE, and CoC in the 28- and 32-mm head sizes. With a head size of 36 mm, MoXLPE had a higher rate of dislocation compared with other materials.
Bearing surface has little impact on revision for dislocation.
脱位是初次全髋关节置换术（THA）后翻修的主要原因。尽管在术后头几年更常见，但脱位可在任何时间发生。本研究调查了THA中陶瓷对陶瓷（CoC）轴承与金属对聚乙烯及陶瓷对聚乙烯轴承相比在晚期脱位方面的差异。
使用澳大利亚骨科协会国家关节置换登记处的数据，采用Kaplan-Meier方法估算不同轴承表面脱位的累积翻修百分比。该研究纳入了192,275例THA，其中101,915例为金属对交联聚乙烯（MoXLPE），30,256例为陶瓷对交联聚乙烯（CoXLPE），60,104例为CoC。
MoXLPE、CoXLPE和CoC组在13年时脱位的累积翻修百分比分别为1.2（95%置信区间[CI]，1.1 - 1.3）、1.0（95% CI，0.7 - 1.4）和0.9（95% CI，0.8 - 1.1）。与CoXLPE和CoC相比，MoXLPE脱位翻修的风险增加。按股骨头大小分层时，在28毫米和32毫米股骨头大小的MoXLPE、CoXLPE和CoC之间，脱位翻修风险无差异。对于36毫米的股骨头大小，MoXLPE的脱位率高于其他材料。
轴承表面对脱位翻修影响不大。
