Castagnini Francesco, Bordini Barbara, Tassinari Enrico, Stea Susanna, Ancarani Cristina, Traina Francesco
Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
J Arthroplasty. 2019 Sep;34(9):2065-2071. doi: 10.1016/j.arth.2019.04.068. Epub 2019 May 10.
Fourth-generation ceramic-on-ceramic couplings were developed to improve ceramic toughness and strength. Encouraging outcomes in primary total hip arthroplasty were reported. This coupling was proposed as an attractive option even in the case of revision procedures, particularly in younger patients with a longer life expectancy. However, the pertinent literature is scarce. Thus, a registry study was conducted to investigate the midterm survival rates and reasons for re-revision of the fourth-generation ceramic-on-ceramic bearing surfaces in revision hip arthroplasties.
A total of 327 revision implants (all the components were exchanged) with BIOLOX Delta couplings were investigated using the regional orthopedic registry RIPO. The demographics, the survival rates, and the reasons for re-revision were assessed. Revisions with bearings other than Delta were compared.
Delta bearings achieved a survival rate of 90.5% at 7 years, with stable results. Twenty-six (8%) re-revisions occurred at a mean follow-up of 4.1 years. And 2.8% of the re-revisions were due to recurrent dislocations; 1.5% of the cases were due to cup aseptic loosening. Septic loosening occurred in 1.6% of the cases. No ceramic fractures were reported. When compared to revisions with bearings other than Delta-on-Delta, Delta coupling cohort achieved similar performances at 5 and 7 years. Lower, nonsignificant rates of aseptic and septic loosening were reported in Delta cohort.
Delta-on-Delta couplings demonstrated to be reliable bearing surfaces in revision settings at a midterm follow-up. Clinical studies and longer follow-ups are required to investigate potential adverse effects, like squeaking and fractures, and confirm these preliminary findings.
Level III, therapeutic study.
第四代陶瓷对陶瓷关节组件旨在提高陶瓷的韧性和强度。据报道，其在初次全髋关节置换术中取得了令人鼓舞的结果。即使在翻修手术中，这种关节组件也被认为是一个有吸引力的选择，尤其是对于预期寿命较长的年轻患者。然而，相关文献较少。因此，开展了一项登记研究，以调查翻修髋关节置换术中第四代陶瓷对陶瓷关节面的中期生存率及再次翻修的原因。
使用区域骨科登记系统RIPO对327例采用BIOLOX Delta关节组件的翻修植入物（所有组件均进行了更换）进行研究。评估患者的人口统计学数据、生存率及再次翻修的原因，并与使用非Delta关节组件的翻修病例进行比较。
Delta关节组件在7年时的生存率为90.5%，结果稳定。在平均4.1年的随访期内，有26例（8%）进行了再次翻修。其中2.8%的再次翻修是由于复发性脱位；1.5%的病例是由于髋臼无菌性松动。1.6%的病例发生了感染性松动。未报告陶瓷骨折。与使用非Delta对Delta关节组件的翻修病例相比，Delta关节组件组在5年和7年时表现相似。Delta关节组件组报告的无菌性和感染性松动发生率较低，但差异无统计学意义。
在中期随访中，Delta对Delta关节组件在翻修手术中表现出可靠的关节面。需要进行临床研究和更长时间的随访，以调查潜在的不良反应，如摩擦音和骨折，并证实这些初步发现。
三级，治疗性研究。
