Pritchett James W
, 901 Boren Ave #900, Seattle, WA, 98104, USA.
Eur J Orthop Surg Traumatol. 2018 Jan;28(1):37-43. doi: 10.1007/s00590-017-2010-0. Epub 2017 Jun 28.
Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal sensitivity reactions. The range of motion achieved, sexual, and functional outcomes were higher than with other types of total hip replacement. This ceramic-coated tripolar prosthesis using highly cross-linked polyethylene provides full function, complete stability, and low wear to younger, active patients, thus confirming the hypothesis and clinical relevance.
某些体育活动和生活方式需要一个完全稳定且活动度很高的髋关节。采用自然股骨头尺寸和两个活动承重面（即“三极”假体）的全髋关节置换术是最稳定的假体。精致的设计和耐磨的承重面是植入物长期存活的关键。假设是使用高度交联聚乙烯的陶瓷涂层三极假体能够在低磨损情况下提供全功能和完全稳定性。本研究旨在确定：（1）患者报告的结果，（2）功能结果，（3）植入物存活率和并发症，以及（4）术后性功能限制。1998年至2011年期间，作者对参与冒险运动和其他体力要求较高活动的患者进行了160例使用三极假体的初次全髋关节置换术。机构审查委员会批准了本研究。纳入标准为需要不受限制活动且不适合或未选择髋关节表面置换的患者。每两年对患者进行随访，并通过X线片、Harris髋关节评分、WOMAC评分、SF - 12评分和加州大学洛杉矶分校（UCLA）功能结果评分进行评估。询问患者关于不稳定症状以及对髋关节置换术的满意度。在术前和术后2年分别询问患者四个关于其性活动的问题。平均随访时间为11年。术后2年时，98%的患者报告其满意度为优秀或良好，99%的患者术后性功能不受限。74%的患者报告他们在术后6周内康复。无脱位情况。有3例因植入物松动、感染和假体周围骨折进行了翻修手术，但三极关节无失败情况。术后UCLA评分的平均值为高水平运动员的8分。无骨溶解、磨损或金属敏感反应迹象。所实现的活动范围、性功能和功能结果均高于其他类型的全髋关节置换术。这种使用高度交联聚乙烯的陶瓷涂层三极假体为年轻、活跃的患者提供了全功能、完全稳定性和低磨损，从而证实了该假设及临床相关性。
