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50 岁以前行髋关节表面置换术:一项平均随访 5.1 年的 979 髋前瞻性研究。

Hip resurfacing before 50years of age: A prospective study of 979 hips with a mean follow-up of 5.1years.

机构信息

Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, 59000 Lille, France; Service d'orthopédie, hôpital salengro, CHU Lille, place de Verdun, 59000 Lille, France.

Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie, hôpital salengro, CHU Lille, place de Verdun, 59000 Lille, France.

出版信息

Orthop Traumatol Surg Res. 2018 May;104(3):295-299. doi: 10.1016/j.otsr.2017.10.018. Epub 2017 Dec 23.

Abstract

BACKGROUND

Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) for the treatment of hip osteoarthritis in patients younger than 50 years. Data on revision rates after HRA are conflicting. The National Institute for Health and Care Excellence (NICE) recommends performing only those hip arthroplasty procedures associated with 10-year revision rates no greater than 5% (0.5% per year). Follow-up studies can rapidly determine whether this criterion is met. The uncertainties surrounding revision rates after HRA prompted us to design a study of prospectively enrolled patients aiming (1) to determine the revision rate after HRA performed before 50years of age and (2) to assess the functional, radiological, and biological outcomes of HRA.

HYPOTHESIS

The revision rate after HRA performed before 50years of age meets the NICE criterion.

MATERIAL AND METHODS

Consecutive patients undergoing HRA before 50years of age were enrolled prospectively. The same implant was used in all patients. Functional outcomes were assessed based on the Harris Hip Score (HHS), Postel-Merle d'Aubigné (PMA) score, 12-item Oxford Hip Score (OHS), and UCLA activity score. Radiographic outcomes were assessed, and blood levels of chromium and cobalt were assayed.

RESULTS

The study included 936 patients (979 HRAs) with a mean age of 42.7years (16.4-50.0years) at surgery and a mean follow-up of 5.1years (range: 3.1-9.0 years). All four mean functional scores were significantly improved at last follow-up vs. baseline: HHS, 95.9 (39.0-100) vs. 44.3 (18.0-83.0); PMA score, 17.6 (6.0-18.0) vs. 11.7 (3.0-16.0); OHS, 14.3 (12.0-37.0) vs. 40.6 (25.0-60.0); and UCLA activity score, 7.8 (2.0-10.0) vs. 5.6 (1.0-10.0) (p<0.0001). Mean cup inclination in the coronal plane was 42.1° (25.0°-68.0°). Mean blood cobalt level was significantly higher at last follow-up than at baseline (1.36μg/L [0.05-8.2μg/L] vs. 0.61μg/L [0.01-3.6]) (p<0.001). No patient experienced dislocation. Revision was required for 17 hips and involved changing the implant in 12 (1.2%). The 10-year survival rate with implant change, as the endpoint was 98.7% (95%CI, 97.6%-99.3%), indicating that the NICE criterion was easily met.

DISCUSSION

The NICE criterion allows the rapid identification of prostheses with insufficient survival. HRA is theoretically associated with a high risk of aseptic mechanical loosening, as it is performed in young patients who have a high level of physical activity. Nevertheless, our study showed that implant survival after HRA was better than required by the NICE criterion. Thus, HRA is a valid alterative to THA in patients younger than 50years.

LEVEL OF EVIDENCE

IV, prospective study with no control group.

摘要

背景

髋关节表面置换术(HRA)是治疗 50 岁以下髋关节骨关节炎的一种替代全髋关节置换术(THA)的方法。关于 HRA 后翻修率的数据存在争议。国家卫生与保健卓越研究所(NICE)建议仅进行那些 10 年翻修率不超过 5%(0.5%/年)的髋关节置换术。随访研究可以快速确定是否符合这一标准。HRA 后翻修率的不确定性促使我们设计了一项前瞻性入组患者的研究,旨在(1)确定 50 岁以下患者行 HRA 后的翻修率,(2)评估 HRA 的功能、影像学和生物学结果。

假设

50 岁以下行 HRA 的翻修率符合 NICE 标准。

材料和方法

前瞻性入组 50 岁以下行 HRA 的连续患者。所有患者均使用相同的植入物。功能结果基于 Harris 髋关节评分(HHS)、Postel-Merle d'Aubigné(PMA)评分、12 项牛津髋关节评分(OHS)和 UCLA 活动评分进行评估。评估影像学结果,并检测血铬和钴水平。

结果

该研究纳入了 936 例患者(979 例 HRA),手术时平均年龄为 42.7 岁(16.4-50.0 岁),平均随访时间为 5.1 年(范围:3.1-9.0 年)。与基线相比,所有四个平均功能评分在最后随访时均显著提高:HHS,95.9(39.0-100)vs. 44.3(18.0-83.0);PMA 评分,17.6(6.0-18.0)vs. 11.7(3.0-16.0);OHS 评分,14.3(12.0-37.0)vs. 40.6(25.0-60.0);和 UCLA 活动评分,7.8(2.0-10.0)vs. 5.6(1.0-10.0)(p<0.0001)。冠状面平均杯倾斜度为 42.1°(25.0°-68.0°)。与基线相比,最后随访时的平均钴血水平显著升高(1.36μg/L [0.05-8.2μg/L] vs. 0.61μg/L [0.01-3.6])(p<0.001)。无患者发生脱位。17 髋需要翻修,其中 12 髋(1.2%)需要更换植入物。以更换植入物为终点,10 年生存率为 98.7%(95%CI,97.6%-99.3%),表明 NICE 标准很容易达到。

讨论

NICE 标准允许快速识别生存不足的假体。HRA 理论上与无菌性机械松动的风险较高相关,因为它是在活动水平较高的年轻患者中进行的。然而,我们的研究表明,HRA 后植入物的存活率优于 NICE 标准要求。因此,HRA 是 50 岁以下患者 THA 的有效替代方法。

证据水平

IV,无对照组的前瞻性研究。

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