Higuchi Yoshitoshi, Seki Taisuke, Morita Daigo, Komatsu Daigo, Takegami Yasuhiko, Ishiguro Naoki
Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japão.
Rev Bras Ortop (Sao Paulo). 2019 May;54(3):295-302. doi: 10.1055/s-0039-1691762. Epub 2019 Jun 27.
Currently, there is a lack of evidence on the medium-term follow-up of cementless total hip arthroplasty (THA) using metal on highly cross-linked polyethylene (MoP), ceramic-on-ceramic (CoC), and metal-on-metal (MoM) bearings. Our aim was to calculate the 5- to 10-year wear rate and the incidence rate of osteolysis for 3 types of bearings. A total of 77 patients underwent MoP, 105 underwent ceramic CoC, and 55 underwent MoM THAs. The average patient age at the time of surgery was 64.7, 55.9, and 59.9 years old in the MoP, CoC, and MoM bearings, respectively. Clinical and radiologic measurements at a mean follow-up of 7.6 years were analyzed. The mean postoperative Harris hip scores showed no difference among the groups. The mean annual liner wear rates were 0.0160, 0.0040 and 0.0054 mm/year in MoP, CoC bearings, and MoM bearings, with that of CoC bearings being significantly lower than the others. Osteolysis (14.5%) among MoM bearings was significantly more frequently observed compared with the others. Kaplan-Meier survival at 10 years with implant loosening, or revision THA as the endpoint, was 96.1% (95% confidence interval [CI]: 88.4-98.7) for MoP, 98.6% (95% CI: 90.3-98.6) for CoC bearing, and 98.2% (95% CI: 88.0-99.7) for MoM bearings ( = 0.360). Excellent clinical and radiological outcomes were obtained for MoP and CoC bearings.
目前，对于使用金属与高交联聚乙烯（MoP）、陶瓷对陶瓷（CoC）以及金属对金属（MoM）轴承的非骨水泥型全髋关节置换术（THA）的中期随访，缺乏相关证据。我们的目的是计算这三种类型轴承5至10年的磨损率和骨溶解发生率。
共有77例患者接受了MoP型THA，105例接受了陶瓷CoC型THA，55例接受了MoM型THA。MoP、CoC和MoM轴承组患者手术时的平均年龄分别为64.7岁、55.9岁和59.9岁。对平均随访7.6年时的临床和影像学测量结果进行了分析。
术后平均Harris髋关节评分在各组之间无差异。MoP、CoC轴承和MoM轴承的平均每年内衬磨损率分别为0.0160、0.0040和0.0054mm/年，CoC轴承的磨损率显著低于其他两组。与其他组相比，MoM轴承组的骨溶解发生率（14.5%）显著更高。以植入物松动或翻修THA为终点的10年Kaplan-Meier生存率，MoP组为96.1%（95%置信区间[CI]：88.4 - 98.7），CoC轴承组为98.6%（95%CI：90.3 - 98.6），MoM轴承组为98.2%（95%CI：88.0 - 99.7）（P = 0.360）。
MoP和CoC轴承获得了良好的临床和影像学结果。
