Department of Orthopaedic Surgery, Dunedin Public Hospital, Southern District Health Board, Dunedin, New Zealand.
Division of Health Sciences, Centre for Biostatistics, University of Otago, Dunedin, New Zealand.
J Arthroplasty. 2019 Nov;34(11):2711-2717. doi: 10.1016/j.arth.2019.06.031. Epub 2019 Jun 20.
Despite increased use of uncemented and hybrid fixation, there is little evidence of their superiority over cemented implants. The aim of this study is to compare the long-term survivorship of cemented, hybrid and uncemented total hip arthroplasty (THA) at varying ages.
A total of 2156 hips (1315 cemented, 324 uncemented, and 517 hybrid) were performed in a single center between 1999 and 2005 with follow-up through to 2017. Registry and local databases were used to determine revision rates and cause. Unadjusted and adjusted competing risk survival analysis was performed.
The cumulative incidence of all-cause revision at 18 years was cemented 10.9%, uncemented 8.9%, and hybrid 6.5%. Cemented fixation had a statistically significant higher risk of all-cause revision than hybrid in the adjusted model for all ages to 65 years (subhazard ratios [SHRs], 2.28-4.67) and a higher risk of revision for loosening, wear, or osteolysis at all ages (SHRs, 3.25-6.07). Uncemented fixation showed no advantage over hybrid fixation at any age, but did show advantages over cemented at younger ages (≤60 years) for all-cause revision (SHRs, 2.3-4.3).
Hybrid fixation with conventional polyethylene shows an advantage over cemented hips at all ages. Uncemented THA showed improved survival over cemented only at younger ages and no advantage over hybrid THA.
尽管非骨水泥固定和混合固定的应用有所增加，但几乎没有证据表明它们比骨水泥固定植入物更具优势。本研究旨在比较不同年龄段骨水泥固定、混合固定和非骨水泥固定全髋关节置换术（THA）的长期生存率。
在 1999 年至 2005 年期间，在一家中心进行了总共 2156 例髋关节手术（1315 例骨水泥固定、324 例非骨水泥固定和 517 例混合固定），随访至 2017 年。使用登记处和当地数据库来确定翻修率和原因。进行了未调整和调整后的竞争风险生存分析。
在 18 年时，所有原因翻修的累积发生率分别为骨水泥固定组 10.9%、非骨水泥固定组 8.9%和混合固定组 6.5%。在调整后的模型中，对于所有年龄至 65 岁的患者，骨水泥固定的全因翻修风险明显高于混合固定（亚危险比[SHR]，2.28-4.67），且在所有年龄段（SHR，3.25-6.07）发生松动、磨损或骨溶解的翻修风险更高。在任何年龄段，非骨水泥固定都没有优于混合固定，但在较年轻（≤60 岁）的患者中，非骨水泥固定的全因翻修风险较低（SHR，2.3-4.3）。
在所有年龄段，常规聚乙烯混合固定均优于骨水泥固定。非骨水泥 THA 仅在较年轻的患者中优于骨水泥固定，而在混合固定中没有优势。
