Halawi Mohamad J, Oak Sameer R, Brigati David, Siggers Aretha, Messner William, Brooks Peter J
Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, A40, Cleveland 44195, OH, United States.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.
J Clin Orthop Trauma. 2018 Oct-Dec;9(4):285-288. doi: 10.1016/j.jcot.2017.05.004. Epub 2017 May 23.
The optimal reconstructive method for advanced degenerative hip disease in young adults is a topic of ongoing discussion. The purpose of this study is to report the largest single institution experience from the United States on the outcomes of Birmingham hip resurfacing (BHR) vs. cementless total hip arthroplasty (THA) in patients 55 years or younger at a minimum follow-up of five years. Currently, BHR is the only FDA-approved hip resurfacing implant available in the US.
A cohort of 505 patients representing all BHR cases performed at our institution between 2006 and 2010 was compared with an identical size cohort of consecutive patients who underwent primary cementless THA. Exclusion criteria were age greater than 55 years, non-elective cases, revision procedures, and those performed for fractures, tumors, or by low-volume arthroplasty surgeons. THAs with metal on metal articulation were also excluded.
assessed were all-cause reoperations, complications, patient satisfaction, and mortality. After exclusions, 442 patients with BHR and 327 with THA were included.
Mean follow-up was 73.2 months. After controlling for potential confounding factors, multivariate analyses showed significant increase in the rates of revision surgery (p < 0.001), overall complications (p < 0.001), all-cause reoperations (p = 0.014), and mortality (p < 0.001) in the THA cohort. Component loosening was the most common cause for revision in the THA group. Patients with THA were also less likely to be satisfied (p = 0.046).
This is largest US study to report on the midterm outcomes of BHR vs. THA. The results demonstrate favorable results for BHR in patients 55 years or younger. Long-term multicenter studies are needed to better understand the optimal patient characteristics when deciding between THA versus BHR.
针对年轻成人晚期退行性髋关节疾病的最佳重建方法仍是一个有待持续探讨的话题。本研究的目的是报告美国一家机构关于55岁及以下患者接受伯明翰髋关节表面置换术（BHR）与非骨水泥全髋关节置换术（THA）至少五年随访结果的最大规模单机构经验。目前，BHR是美国食品药品监督管理局（FDA）批准的唯一一种髋关节表面置换植入物。
将2006年至2010年间在本机构进行的所有505例BHR病例组成的队列与相同规模的连续接受初次非骨水泥THA的患者队列进行比较。排除标准为年龄大于55岁、非择期病例、翻修手术以及因骨折、肿瘤或由低手术量关节置换外科医生进行的手术。金属对金属关节的THA也被排除。
评估的指标包括全因再次手术、并发症、患者满意度和死亡率。排除后，纳入442例接受BHR的患者和327例接受THA的患者。
平均随访73.2个月。在控制潜在混杂因素后，多变量分析显示THA队列的翻修手术率（p < 0.001）、总体并发症（p < 0.001）、全因再次手术率（p = 0.014）和死亡率（p < 0.001）显著增加。组件松动是THA组翻修的最常见原因。接受THA的患者也不太可能满意（p = 0.046）。
这是美国关于BHR与THA中期结果报告的最大规模研究。结果表明BHR在55岁及以下患者中取得了良好效果。需要进行长期多中心研究，以便在决定采用THA还是BHR时更好地了解最佳患者特征。
