Department of Orthopedics, Mayo Clinic, Rochester, Minnesota.
Department of Orthopedics, Medical University Vienna, Vienna, Austria.
J Bone Joint Surg Am. 2019 Mar 6;101(5):421-428. doi: 10.2106/JBJS.18.00522.
Polyethylene (PE) liner and femoral head exchange is commonly used to treat periprosthetic osteolysis associated with PE wear after total hip arthroplasty (THA). The purpose of our study was to determine long-term implant survivorship, risk factors for mechanical failure, clinical outcomes, and complications following PE liner and head exchange.
We identified 116 hips in 110 patients treated with PE liner and head exchange from 1993 to 2004. There were 64 women (58%) in the series, the mean age at revision surgery was 58 years, and the mean follow-up was 11 years (range, 2 to 23 years). Radiographic review determined the location and size of osteolytic defects before the revision surgery. Implant survivorship was determined using Kaplan-Meier survival analysis. Cox regression analysis was used to determine factors that were predictive of failure.
Implant survivorship free of repeat revision for any cause was 91% (95% confidence interval [CI] = 86% to 96%) at 5 years, 81% (95% CI = 74% to 90%) at 10 years, and 69% (95% CI = 55% to 84%) at 15 years. Reasons for repeat revision included aseptic acetabular loosening in 5 hips (4%) and subsequent wear of conventional PE with osteolysis in 5 hips (4%). No patient who underwent revision with highly cross-linked PE subsequently had a repeat revision due to wear. The absolute risk of acetabular component loosening was 23% for patients with osteolysis in 3 zones, 40% for those with osteolysis involving more than half the cup circumference, and 21% for those with osteolytic defects of >600 mm. The mean Harris hip score improved from 77 before the PE liner and head exchange to 87 after it (p < 0.001). The most common complication was dislocation, which occurred in 19 hips (16%).
PE liner and head exchange provides acceptable long-term implant survivorship with good clinical outcomes. Complications are not uncommon, and steps should be taken to mitigate hip instability. Acetabular revision may be considered when in situ components have a poor track record or are malpositioned, or when preoperative radiographs demonstrate large osteolytic defects threatening cup fixation. Use of highly cross-linked PE at revision was protective against subsequent PE wear and osteolysis, although this did not reach significance.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
聚乙烯（PE）衬垫和股骨头置换术常用于治疗全髋关节置换术后与 PE 磨损相关的假体周围骨溶解。我们的研究目的是确定 PE 衬垫和股骨头置换术后的长期植入物存活率、机械故障的风险因素、临床结果和并发症。
我们从 1993 年至 2004 年期间确定了 110 名患者的 116 髋接受了 PE 衬垫和股骨头置换术治疗。该系列中包括 64 名女性（58%），翻修手术时的平均年龄为 58 岁，平均随访时间为 11 年（范围 2 至 23 年）。放射学检查确定了翻修术前骨溶解缺陷的位置和大小。使用 Kaplan-Meier 生存分析确定植入物存活率。Cox 回归分析用于确定预测失败的因素。
因任何原因进行重复翻修而无植入物失败的存活率为 5 年时为 91%（95%置信区间[CI] = 86%至 96%），10 年时为 81%（95% CI = 74%至 90%），15 年时为 69%（95% CI = 55%至 84%）。重复翻修的原因包括 5 髋（4%）无菌性髋臼松动和 5 髋（4%）随后出现常规 PE 磨损伴骨溶解。没有因高交联 PE 翻修而再次出现磨损的患者需要再次翻修。髋臼部件松动的绝对风险为 3 区骨溶解患者为 23%，髋臼杯周长超过一半骨溶解患者为 40%，骨溶解缺陷>600mm 的患者为 21%。PE 衬垫和股骨头置换术前的 Harris 髋关节评分为 77 分，术后为 87 分（p<0.001）。最常见的并发症是脱位，共发生在 19 髋（16%）。
PE 衬垫和股骨头置换术可提供可接受的长期植入物存活率和良好的临床结果。并发症并不少见，应采取措施减轻髋关节不稳定。当原位组件记录不佳或位置不当，或术前 X 线片显示大的骨溶解缺陷威胁到杯固定时，可考虑进行髋臼翻修。尽管尚未达到显著水平，但在翻修时使用高交联 PE 可防止随后发生 PE 磨损和骨溶解。
治疗性 IV 级。请参阅作者说明以获取完整的证据水平描述。
