Barrow Jonathan A, Divecha Hiren M, Panchani Sunil, Boden Richard, Chitre Amol, Gambhir Anil, Porter Martyn L, Board Tim N
Centre for Hip Surgery, Wrightington Hospital, Appley Bridge, Wigan, WN4 9EP, UK.
Royal Preston Hospital, Sharoe Green Lane North, Fulwood, Preston, PR2 9HT, UK.
Eur J Orthop Surg Traumatol. 2019 Aug;29(6):1243-1251. doi: 10.1007/s00590-019-02426-2. Epub 2019 Mar 30.
The ideal method and implant to perform total hip arthroplasty (THA) is still a debated topic. Ceramic on ceramic (CoC) bearings have favourable wear properties, but squeaking has been reported as an unwanted side effect. We aimed to determine the rate of noise generation from CoC hips and investigate whether there is a relationship with patient satisfaction.
A total of 246 consecutive CoC bearing uncemented THA were retrospectively identified in a single institution. Post-operatively patients were sent a postal questionnaire to evaluate their reported sounds and satisfaction with their THA. Uni- and multi-variate analyses were performed to identify potential predictor variables for reported post-operative sounds.
Questionnaires were returned by 172 patients (70% return rate). 24% reported sounds from their hips with 11% reporting a squeak. Median satisfaction levels were minimally, but significantly less for "noisy" (9/10) than "quiet" hips (10/10) (median difference = - 1, 95% CI - 2 to 0, p < 0.001). Compared to those with "noisy" hips, patients with "quiet" hips were 1.7 times (95% CI 1.3-2.5, p = 0.0002) more likely to report a "forgotten" hip. Younger age (p < 0.043) and increased anteversion (p < 0.021) were predictors for reported sounds.
We have identified a high rate of "noisy" hips in this series of CoC THA with a significant inverse relationship between "noisy" hips and patient satisfaction levels. In our unit, we are moving towards the use of ceramic on cross-linked polyethylene bearings as a result of these findings and the excellent survivorship of this bearing combination.
进行全髋关节置换术（THA）的理想方法和植入物仍是一个有争议的话题。陶瓷对陶瓷（CoC）轴承具有良好的耐磨性能，但有报道称会产生令人讨厌的吱吱声这一边缘效应。我们旨在确定CoC髋关节产生噪音的发生率，并调查其与患者满意度之间是否存在关系。
在单一机构中对246例连续的采用CoC轴承的非骨水泥型THA进行回顾性分析。术后向患者发送邮寄问卷，以评估他们所报告的髋关节声音以及对THA的满意度。进行单变量和多变量分析，以确定报告的术后声音的潜在预测变量。
172例患者（回复率70%）返回了问卷。24%的患者报告髋关节有声音，其中11%报告有吱吱声。“有噪音”髋关节（9/10）的中位满意度略低于但显著低于“安静”髋关节（10/10）（中位差异=-1，95%CI -2至0，p<0.001）。与“有噪音”髋关节的患者相比，“安静”髋关节的患者报告“已遗忘”髋关节的可能性高1.7倍（95%CI 1.3-2.5，p=0.0002）。年龄较小（p<0.043）和前倾角增加（p<0.021）是报告有声音的预测因素。
在这一系列CoC THA中，我们发现“有噪音”髋关节的发生率很高，且“有噪音”髋关节与患者满意度之间存在显著的负相关。基于这些发现以及这种轴承组合出色的生存率，我们科室正转向使用陶瓷对交联聚乙烯轴承。
