Department of Orthopaedic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
J Bone Joint Surg Am. 2018 Nov 7;100(21):1879-1887. doi: 10.2106/JBJS.17.01525.
International surgeon series and registry data have demonstrated positive outcomes and long-term survival of the Birmingham Hip Resurfacing (BHR) implant. We report the 5 to 10-year results from a single center in the U.S.
Three hundred and fourteen patients (360 hips) underwent surface replacement arthroplasty with use of the BHR implant and consented to study participation. Patient-reported outcomes and complication and revision data were collected at a minimum of 5 years of follow-up for 93% (324 of 350) of the hips in surviving patients. A matched-cohort analysis was used to compare clinical outcomes between use of the BHR and total hip arthroplasty.
Mean modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores significantly improved postoperatively, to 89.9 and 8.0, respectively (p < 0.001). The Kaplan-Meier estimated rate of survival for all-cause revision was 97.2% (95% confidence interval [CI], 94.7% to 98.5%) and 93.8% (95% CI, 88.8% to 96.7%) at 5 and 10 years, respectively. In a subgroup analysis of patients fitting our current BHR inclusion criteria (males <60 years of age with a diagnosis of osteoarthritis and anatomy conducive to a femoral head component of ≥48 mm), survival free of aseptic revision was 99.5% (95% CI, 96.6% to 99.9%) at 5 years and 98.2% (95% CI, 94.4% to 99.4%) at 10 years. Fourteen patients (4.3% of all hips) required revision. Postoperative UCLA scores were significantly greater for BHR compared with total hip arthroplasty (mean score of 8.0 ± 2.0 versus 7.6 ± 1.8; p = 0.040) in a matched-cohort analysis, with patients matched according to preoperative UCLA score, diagnosis, age, sex, and body mass index. Among matched patients who were highly active preoperatively (UCLA score of 9 to 10), BHR provided a smaller median decrease in the postoperative UCLA score (0.0 versus 1.0; p < 0.001), which was clinically important according to the minimal clinically important difference (MCID, 0.92). Furthermore, BHR provided a greater likelihood of remaining highly active compared with total hip arthroplasty (61% compared with 20%; p < 0.001).
BHR demonstrated excellent survivorship and clinical outcomes at 5 to 10 years in selected patients. As compared with total hip arthroplasty, the use of the BHR may provide highly active patients with clinically important advantages in postoperative activity as well as a greater likelihood of remaining highly active. Continued follow-up is necessary to validate long-term BHR outcomes.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
国际外科医生系列和注册研究数据表明， Birmingham Hip Resurfacing（BHR）植入物具有良好的治疗效果和长期存活率。我们报告了在美国的一家单中心机构的 5 至 10 年的研究结果。
314 名患者（360 髋）接受了 Birmingham Hip Resurfacing（BHR）植入物的表面置换关节成形术，并同意参与研究。在随访 5 年以上的存活患者中，有 93%（324/350）收集了患者报告的结果和并发症及翻修数据。使用匹配队列分析比较了 BHR 和全髋关节置换术的临床结果。
改良 Harris 髋关节评分（mHHS）和加州大学洛杉矶分校（UCLA）评分均显著改善，分别为 89.9 和 8.0（p<0.001）。全因翻修的 Kaplan-Meier 估计生存率为 97.2%（95%置信区间[CI]：94.7%至 98.5%）和 93.8%（95%CI：88.8%至 96.7%），分别为 5 年和 10 年。在符合我们目前 BHR 纳入标准的患者亚组分析中（男性<60 岁，诊断为骨关节炎，且股骨头部份适合≥48mm），无无菌性翻修的生存率为 99.5%（95%CI：96.6%至 99.9%），在 10 年时为 98.2%（95%CI：94.4%至 99.4%）。有 14 名患者（所有髋关节的 4.3%）需要翻修。在匹配队列分析中，BHR 的术后 UCLA 评分明显高于全髋关节置换术（平均评分为 8.0±2.0 比 7.6±1.8；p=0.040），患者按照术前 UCLA 评分、诊断、年龄、性别和体重指数进行匹配。在术前高度活跃的匹配患者中（UCLA 评分为 9 至 10），BHR 术后 UCLA 评分的中位数下降幅度较小（0.0 比 1.0；p<0.001），根据最小临床重要差异（MCID，0.92），这具有临床重要意义。此外，BHR 使患者保持高度活跃的可能性显著高于全髋关节置换术（61%比 20%；p<0.001）。
在选定的患者中，BHR 在 5 至 10 年时表现出极好的存活率和临床结果。与全髋关节置换术相比，BHR 的使用可能为高度活跃的患者提供术后活动方面具有重要临床意义的优势，并且更有可能保持高度活跃。需要进一步的随访来验证 BHR 的长期结果。
治疗性 III 级。请参阅作者说明，以获取完整的证据级别描述。
