Matharu G S, Hunt L P, Murray D W, Howard P, Pandit H G, Blom A W, Bolland B, Judge A
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD UK, and Research Fellow at the Musculoskeletal Research Unit and Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK.
Musculoskeletal Research Unit, Department of Translational Health Sciences, University of Bristol, Bristol BS10 5NB, UK.
Bone Joint J. 2018 Jan;100-B(1):33-41. doi: 10.1302/0301-620X.100B1.BJJ-2017-0625.R2.
The aim of this study was to determine whether the rates of revision for metal-on-metal (MoM) total hip arthroplasties (THAs) with Pinnacle components varied according to the year of the initial operation, and compare these with the rates of revision for other designs of MoM THA.
Data from the National Joint Registry for England and Wales included 36 mm MoM THAs with Pinnacle acetabular components which were undertaken between 2003 and 2012 with follow-up for at least five years (n = 10 776) and a control group of other MoM THAs (n = 13 817). The effect of the year of the primary operation on all-cause rates of revision was assessed using Cox regression and interrupted time-series analysis.
For MoM THAs involving Pinnacle components, those undertaken between 2007 and 2012 had higher rates of revision compared with those undertaken between 2004 and 2006 (hazard ratio (HR) 2.01; 95% confidence interval (CI) 1.57 to 2.57; p < 0.001). For THAs undertaken during and after 2007, the number of revisions per 1000 implant-years at risk significantly increased by 5.20 (95% CI 0.52 to 9.89; p = 0.033) compared with those undertaken before this time. In the control group, THAs undertaken between 2007 and 2012 also had higher rates of revision (HR 1.77; 95% CI 1.49 to 2.10; p < 0.001), with revisions per 1000 implant-years for those undertaken during and after 2007 significantly increasing by 6.13 (95% CI 1.42 to 10.83; p = 0.016).
The five-year revision rates were significantly increased for all primary MoM THAs undertaken from 2007 onwards. Contrary to recent reports, this finding was not specific to those involving Pinnacle acetabular components and may be explained by increased surveillance and recent lowering of the threshold for revision. Cite this article: 2018;100-B:33-41.
本研究旨在确定采用Pinnacle组件的金属对金属（MoM）全髋关节置换术（THA）的翻修率是否随初次手术年份而变化，并将其与其他设计的MoM THA的翻修率进行比较。
来自英格兰和威尔士国家关节注册中心的数据包括2003年至2012年间采用Pinnacle髋臼组件的36毫米MoM THA，且随访至少五年（n = 10776），以及一组其他MoM THA的对照组（n = 13817）。使用Cox回归和中断时间序列分析评估初次手术年份对全因翻修率的影响。
对于采用Pinnacle组件的MoM THA，2007年至2012年间进行的手术与2004年至2006年间进行的手术相比，翻修率更高（风险比（HR）2.01；95%置信区间（CI）1.57至2.57；p < 0.001）。对于2007年及之后进行的THA，与在此之前进行的相比，每1000个植入物年的翻修数量显著增加5.20（95% CI 0.52至9.89；p = 0.033）。在对照组中，2007年至2012年间进行的THA翻修率也更高（HR 1.77；95% CI 1.49至2.10；p < 0.001），2007年及之后进行的每1000个植入物年的翻修数量显著增加6.13（95% CI 1.42至10.83；p = 0.016）。
2007年起进行的所有初次MoM THA的五年翻修率均显著增加。与近期报告相反，这一发现并非特定于采用Pinnacle髋臼组件的手术，可能是由于监测增加以及近期翻修阈值降低所致。引用本文：2018；100 - B：33 - 41。
