Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.
Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), Chapel Allerton Hospital, Leeds, United Kingdom.
J Bone Joint Surg Am. 2018 Jul 5;100(13):1132-1140. doi: 10.2106/JBJS.17.00718.
Studies have suggested that Trabecular Metal (TM)-coated acetabular components may reduce implant failure following revision total hip arthroplasty. However, these studies have predominantly been limited to small, single-center cohorts, with many lacking a comparator group. Using National Joint Registry data from England and Wales, we compared re-revision rates following revision total hip arthroplasty between TM and non-TM-coated acetabular components from 1 manufacturer.
This retrospective observational study included all revision total hip arthroplasties performed with use of 1 of 4 cementless acetabular components produced by the same manufacturer (Zimmer Biomet). The acetabular components either had a TM surface coating (TM Modular and Continuum designs) or a non-TM surface coating (Trilogy and Trilogy IT designs). Revision total hip arthroplasties with TM and non-TM implants were matched for multiple potential patient and surgical confounding factors using propensity scores. Outcomes following revision total hip arthroplasty (re-revision for all acetabular indications, aseptic acetabular loosening, or infection) were compared between matched groups using competing risk regression analysis. Analyses were repeated in a subgroup initially revised for infection.
Of 3,862 matched revision total hip arthroplasties (1,931 in the TM group and 1,931 in the non-TM group), the overall prevalence of acetabular re-revision (2.7%; 95% confidence interval [CI] = 2.1% to 3.2%), re-revision for aseptic acetabular loosening (0.96%; 95% CI = 0.68% to 1.3%), and re-revision for infection (1.4%; 95% CI = 1.0% to 1.8%) were low. Six-year rates of re-revision for all causes (subhazard ratio [SHR] = 0.91; 95% CI = 0.61 to 1.35; p = 0.636), aseptic acetabular loosening (SHR = 1.32; 95% CI = 0.68 to 2.53; p = 0.410), and infection (SHR = 0.68; 95% CI = 0.39 to 1.20; p = 0.165) were similar between revision total hip arthroplasties with TM and non-TM coatings. Of 247 total hip arthroplasties initially revised for infection (116 TM and 131 non-TM), the rates of re-revision for all causes (SHR = 0.48; 95% CI = 0.15 to 1.56; p = 0.225), aseptic acetabular loosening (SHR = 0.54; 95% CI = 0.05 to 5.74; p = 0.608), and infection (SHR = 0.82; 95% CI = 0.28 to 2.36; p = 0.706) were similar between the TM and non-TM groups.
Following revision total hip arthroplasty, TM-coated acetabular components had a low risk of both aseptic and septic re-revision, with rates that were comparable with those of non-TM components. Extended follow-up of large revision total hip arthroplasty cohorts will establish whether TM components have any clinical benefit over non-TM designs when used in patients with similar acetabular bone stock.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
研究表明，经小梁金属（TM）涂层的髋臼部件可能会降低翻修全髋关节置换术后的植入物失败率。然而，这些研究主要局限于小的、单中心队列，许多研究缺乏对照组。利用来自英格兰和威尔士的国家关节登记数据，我们比较了同一家制造商生产的 1 种非 TM 涂层髋臼部件的翻修全髋关节置换术后的再翻修率。
本回顾性观察性研究纳入了所有使用同一家制造商（捷迈邦美）生产的 4 种非骨水泥髋臼部件之一进行的翻修全髋关节置换术。髋臼部件要么具有 TM 表面涂层（TM Modular 和 Continuum 设计），要么具有非 TM 表面涂层（Trilogy 和 Trilogy IT 设计）。使用倾向评分对 TM 和非 TM 植入物的翻修全髋关节置换术进行了多种潜在患者和手术混杂因素的匹配。使用竞争风险回归分析比较匹配组之间的翻修全髋关节置换术后（所有髋臼适应证的再翻修、无菌性髋臼松动或感染）的结局。在最初因感染而翻修的亚组中重复了分析。
在 3862 例匹配的翻修全髋关节置换术中（TM 组 1931 例，非 TM 组 1931 例），髋臼再翻修的总体患病率（2.7%；95%置信区间 [CI]：2.1%至 3.2%）、无菌性髋臼松动的再翻修率（0.96%；95% CI：0.68%至 1.3%）和感染的再翻修率（1.4%；95% CI：1.0%至 1.8%）较低。所有原因的 6 年再翻修率（亚危险比 [SHR] = 0.91；95% CI：0.61 至 1.35；p = 0.636）、无菌性髋臼松动的再翻修率（SHR = 1.32；95% CI：0.68 至 2.53；p = 0.410）和感染的再翻修率（SHR = 0.68；95% CI：0.39 至 1.20；p = 0.165）在 TM 和非 TM 涂层的翻修全髋关节置换术中相似。在 247 例最初因感染而翻修的全髋关节置换术中（TM 组 116 例，非 TM 组 131 例），所有原因的再翻修率（SHR = 0.48；95% CI：0.15 至 1.56；p = 0.225）、无菌性髋臼松动的再翻修率（SHR = 0.54；95% CI：0.05 至 5.74；p = 0.608）和感染的再翻修率（SHR = 0.82；95% CI：0.28 至 2.36；p = 0.706）在 TM 和非 TM 组之间相似。
在翻修全髋关节置换术后，TM 涂层髋臼部件的无菌性和感染性再翻修风险较低，其发生率与非 TM 部件相当。对大量翻修全髋关节置换术队列的进一步随访将确定在具有相似髋臼骨量的患者中使用 TM 部件是否比非 TM 设计具有任何临床优势。
治疗性 III 级。请参阅作者说明，以获取完整的证据水平描述。
