Matharu G S, Judge A, Murray D W, Pandit H G
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences; University of Oxford, Nuffield Orthopaedic Centre, Oxford OX3 7LD, and MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
Bone Joint Res. 2017 Jul;6(7):405-413. doi: 10.1302/2046-3758.67.BJR-2017-0017.R2.
Few studies have assessed outcomes following non-metal-on-metal hip arthroplasty (non-MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD). We assessed outcomes following non-MoMHA revision surgery performed for ARMD, and identified predictors of re-revision.
We performed a retrospective observational study using data from the National Joint Registry for England and Wales. All non-MoMHAs undergoing revision surgery for ARMD between 2008 and 2014 were included (185 hips in 185 patients). Outcome measures following ARMD revision were intra-operative complications, mortality and re-revision surgery. Predictors of re-revision were identified using Cox regression.
Intra-operative complications occurred in 6.0% (n = 11) of the 185 cases. The cumulative four-year patient survival rate was 98.2% (95% CI 92.9 to 99.5). Re-revision surgery was performed in 13.5% (n = 25) of hips at a mean time of 1.2 years (0.1 to 3.1 years) following ARMD revision. Infection (32%; n = 8), dislocation/subluxation (24%; n = 6), and aseptic loosening (24%; n = 6) were the most common re-revision indications. The cumulative four-year implant survival rate was 83.8% (95% CI 76.7 to 88.9). Multivariable analysis identified three predictors of re-revision: multiple revision indications (hazard ratio (HR) = 2.78; 95% CI 1.03 to 7.49; p = 0.043); selective component revisions (HR = 5.76; 95% CI 1.28 to 25.9; p = 0.022); and ceramic-on-polyethylene revision bearings (HR = 3.08; 95% CI 1.01 to 9.36; p = 0.047).
Non-MoMHAs revised for ARMD have a high short-term risk of re-revision, with important predictors of future re-revision including selective component revision, multiple revision indications, and ceramic-on-polyethylene revision bearings. Our findings may help counsel patients about the risks of ARMD revision, and guide reconstructive decisions. Future studies attempting to validate the predictors identified should also assess the effects of implant design (metallurgy and modularity), given that this was an important study limitation potentially influencing the reported prognostic factors. G. S. Matharu, A. Judge, D. W. Murray, H. G. Pandit. Outcomes following revision surgery performed for adverse reactions to metal debris in non-metal-on-metal hip arthroplasty patients: Analysis of 185 revisions from the National Joint Registry for England and Wales. 2017;6:405-413. DOI: 10.1302/2046-3758.67.BJR-2017-0017.R2.
很少有研究评估因金属碎屑不良反应（ARMD）而行非金属对金属髋关节置换术（non-MoMHA）翻修手术后的结果。我们评估了因ARMD而行non-MoMHA翻修手术的结果，并确定了再次翻修的预测因素。
我们使用来自英格兰和威尔士国家关节注册中心的数据进行了一项回顾性观察研究。纳入2008年至2014年间因ARMD接受翻修手术的所有non-MoMHA（185例患者的185髋）。ARMD翻修后的结果指标包括术中并发症、死亡率和再次翻修手术。使用Cox回归确定再次翻修的预测因素。
185例病例中有6.0%（n = 11）发生术中并发症。四年累积患者生存率为98.2%（95%CI 92.9至99.5）。在ARMD翻修后平均1.2年（0.1至3.1年），13.5%（n = 25）的髋关节进行了再次翻修手术。感染（32%；n = 8）、脱位/半脱位（24%；n = 6）和无菌性松动（24%；n = 6）是最常见的再次翻修指征。四年累积植入物生存率为83.8%（95%CI 76.7至88.9）。多变量分析确定了再次翻修的三个预测因素：多个翻修指征（风险比（HR）= 2.78；95%CI 1.03至7.49；p = 0.043）；选择性部件翻修（HR = 5.76；95%CI 1.28至25.9；p = 0.022）；以及陶瓷对聚乙烯翻修轴承（HR = 3.08；95%CI 1.01至9.36；p = 0.047）。
因ARMD而行翻修的non-MoMHA具有较高的短期再次翻修风险，未来再次翻修的重要预测因素包括选择性部件翻修、多个翻修指征和陶瓷对聚乙烯翻修轴承。我们的研究结果可能有助于向患者咨询ARMD翻修的风险，并指导重建决策。鉴于这是一个可能影响所报告预后因素的重要研究局限性，未来试图验证所确定预测因素的研究还应评估植入物设计（冶金和模块化）的影响。G. S. Matharu、A. Judge、D. W. Murray、H. G. Pandit。非金属对金属髋关节置换术患者因金属碎屑不良反应行翻修手术后的结果：对英格兰和威尔士国家关节注册中心185例翻修病例的分析。2017；6：405 - 413。DOI：10.1302/2046 - 3758.67.BJR - 2017 - 0017.R2。
