Miettinen S S A, Mäkinen T J, Mäkelä K, Huhtala H, Kettunen J S, Remes V
1 Department of Orthopedics, Traumatology, and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
2 Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.
Scand J Surg. 2018 Jun;107(2):180-186. doi: 10.1177/1457496917748220. Epub 2018 Jan 15.
Large-diameter head total hip arthroplasty and hip resurfacing arthroplasty were popular in Finland from 2000 to 2012 for the treatment of hip osteoarthritis. The aim of this retrospective study was to investigate the mid-term survival of large-diameter head total hip arthroplasty patients operated on in three university hospitals and to compare these results to the survival of hip resurfacing arthroplasty patients.
A total of 3860 hip arthroplasties (3029 large-diameter head total hip arthroplasties in 2734 patients and 831 hip resurfacing arthroplasties in 757 patients) were operated on between January 2004 and December 2009. The mean follow-up was 4.3 years (range: 0.3-8.0 years) in the total hip arthroplasty group and 5.1 years (range: 1.7-7.9 years) in the hip resurfacing arthroplasty group. Cox multiple regression model and Kaplan-Meier survival analysis were used to study the survival of the total hip arthroplasties and the hip resurfacing arthroplasties. Intraoperative complications and reasons for revisions were also evaluated.
In Cox regression analysis, the hazard ratio for revision of hip resurfacing arthroplasty was 1.5 compared with large-diameter head total hip arthroplasty (95% confidence interval: 1.0-2.2) ( p = 0.029). The cumulative Kaplan-Meier survival rate was 90.7% at 7.7 years for the large-diameter head total hip arthroplasty (95% confidence interval: 86.8-94.6) and 92.2% at 7.6 years for hip resurfacing arthroplasty (95% confidence interval: 89.9-94.6). There were a total of 166/3029 (5.5%) intraoperative complications in the large-diameter head total hip arthroplasty group and 20/831 (2.4%) in the hip resurfacing arthroplasty group ( p = 0.001). Revision for any reason was performed on 137/3029 (4.5%) of the arthroplasties in the large-diameter head total hip arthroplasty group and 52/831 (6.3%) in the hip resurfacing arthroplasty group ( p = 0.04).
The mid-term survival of both of these devices was poor, and revisions due to adverse reactions to metal debris will most likely rise at longer follow-up. There were more intraoperative complications in the large-diameter head total hip arthroplasty group than in the hip resurfacing arthroplasty group.
2000年至2012年期间，大直径股骨头全髋关节置换术和髋关节表面置换术在芬兰常用于治疗髋关节骨关节炎。本回顾性研究的目的是调查在三家大学医院接受手术的大直径股骨头全髋关节置换术患者的中期生存率，并将这些结果与髋关节表面置换术患者的生存率进行比较。
2004年1月至2009年12月期间共进行了3860例髋关节置换术（2734例患者接受了3029例大直径股骨头全髋关节置换术，757例患者接受了831例髋关节表面置换术）。全髋关节置换术组的平均随访时间为4.3年（范围：0.3 - 8.0年），髋关节表面置换术组的平均随访时间为5.1年（范围：1.7 - 7.9年）。采用Cox多元回归模型和Kaplan-Meier生存分析来研究全髋关节置换术和髋关节表面置换术的生存率。还评估了术中并发症及翻修原因。
在Cox回归分析中，髋关节表面置换术翻修的风险比与大直径股骨头全髋关节置换术相比为1.5（95%置信区间：1.0 - 2.2）（p = 0.029）。大直径股骨头全髋关节置换术在7.7年时的累积Kaplan-Meier生存率为90.7%（95%置信区间：86.8 - 94.6），髋关节表面置换术在7.6年时的累积Kaplan-Meier生存率为92.2%（95%置信区间：89.9 - 94.6）。大直径股骨头全髋关节置换术组共有166/3029（5.5%）例术中并发症，髋关节表面置换术组有20/831（2.4%）例（p = 0.001）。大直径股骨头全髋关节置换术组有137/3029（4.5%）例因任何原因进行了翻修手术，髋关节表面置换术组有52/831（6.3%）例（p = 0.04）。
这两种假体的中期生存率都较差，在更长时间的随访中，因金属碎屑不良反应导致的翻修很可能会增加。大直径股骨头全髋关节置换术组的术中并发症比髋关节表面置换术组更多。
