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与对侧陶瓷对陶瓷髋关节置换相比,陶瓷对聚乙烯髋关节置换假体周围骨折的发生率更高:四十年髋关节骨坏死治疗经验。

Higher prevalence of periprosthetic fractures with ceramic on polyethylene hip bearing compared with ceramic on ceramic on the contralateral side: a forty year experience with hip osteonecrosis.

作者信息

Hernigou Philippe, Auregan Jean Charles, Bastard Claire, Housset Victor, Flouzat-Lachaniette Charles Henri, Dubory Arnaud

机构信息

Hôpital Henri Mondor, 94010, Creteil, France.

Hôpital Antoine Beclère, 92000, Clamart, France.

出版信息

Int Orthop. 2018 Jul;42(7):1457-1461. doi: 10.1007/s00264-018-3863-5. Epub 2018 Mar 4.

Abstract

PURPOSE

It is unclear whether late THA periprosthetic femoral fractures are related to a mechanical mechanism that decreases strength of the femur (for example, loosening) or to a biological problem as osteolysis. It is also unknown if ceramic on ceramic bearing couples decrease the risk of late periprosthetic fractures as a result of the absence of wear and osteolysis.

MATERIAL AND METHODS

We therefore asked whether the cumulative long-term fractures were different according to the couple of friction ceramic on ceramic or ceramic on polyethylene in 327 patients (654 hips) with bilateral THA (one ceramic-ceramic, and the contralateral ceramic-polyethylene) who had THA with cemented stems performed between from 1978 to 2000 for osteonecrosis.

RESULTS

There were two intra-operative fractures (0.3%). The median follow-up was 22 years (range, 15-40 years), and at the most recent follow-up, the cumulative number of late (after 7 years of follow-up) post-operative fractures was 32 (5% of 654 hips). Fractures were unilateral, which means for the 327 patients, a 10% rate of fractures. Periprosthetic fractures increased in number with follow-up: seven fractures (1% of 654 hips) occurred within ten years of THA implantation, 20 (3%) within 20 years, 26 (4%) within 30 years, and 32 (5%) within 40 years. The risk of fracture was influenced (p < 0.001) by the bearing surfaces at the time of prosthetic implantation, low (0.3%) for ceramic on ceramic (1/32 fractures; 1/327 hips), high (10%) for ceramic on PE (31/32 fractures; 31/327 hips).

CONCLUSION

In summary, when the contralateral hip of the same patient is the control, after 40 years of follow-up, post-operative fractures occur 30 times more often on the side with PE cup than on the side with ceramic/ceramic bearing.

摘要

目的

目前尚不清楚晚期全髋关节置换术(THA)假体周围股骨骨折是与降低股骨强度的机械机制(如松动)有关,还是与诸如骨溶解等生物学问题有关。同样未知的是,陶瓷对陶瓷的轴承配对是否由于不存在磨损和骨溶解而降低了晚期假体周围骨折的风险。

材料与方法

因此,我们研究了327例(654髋)因骨坏死于1978年至2000年间接受了带骨水泥柄全髋关节置换术的双侧THA患者(一侧为陶瓷对陶瓷,另一侧为陶瓷对聚乙烯),根据陶瓷对陶瓷或陶瓷对聚乙烯的摩擦配对情况,其累积长期骨折情况是否存在差异。

结果

术中发生了两例骨折(0.3%)。中位随访时间为22年(范围15 - 40年),在最近一次随访时,晚期(随访7年后)术后骨折的累积数量为32例(占654髋的5%)。骨折均为单侧,这意味着对于327例患者,骨折发生率为10%。假体周围骨折的数量随随访时间增加:在THA植入后10年内发生7例骨折(占654髋的1%),20年内发生20例(3%),30年内发生26例(4%),40年内发生32例(5%)。假体植入时的轴承表面对骨折风险有影响(p < 0.001),陶瓷对陶瓷的骨折风险低(0.3%)(1/32例骨折;1/327髋),陶瓷对聚乙烯的骨折风险高(10%)(31/32例骨折;31/327髋)。

结论

总之,当同一患者的对侧髋关节作为对照时,经过40年的随访,聚乙烯杯一侧的术后骨折发生率比陶瓷/陶瓷轴承一侧高30倍。

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