Cho Kyu-Jin, Park Kyung-Soon, Jang Won-Young, Park Chun-Gon, Yoon Taek-Rim
Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, South Korea.
Orthopaedic Department, Chonnam National University Hospital, Gwangju, South Korea.
Indian J Orthop. 2019 Sep-Oct;53(5):630-636. doi: 10.4103/ortho.IJOrtho_192_18.
There are limited reports for the results of the fourth-generation ceramic-on-ceramic (CoC) articulation total hip arthroplasty (THA). And, throughout the surgical experience, we encountered some cases of liner pulling-out phenomenon after liner fixation and femoral preparation. The objective of this study was to evaluate the incidence, risk factors of delta ceramic liner or head fractures, and also the clinical and radiological results of using the fourth-generation CoC articulation in THA.
We retrospectively reviewed 242 patients (263 hips) who underwent primary THA using the fourth-generation CoC articulation with a minimum followup of 2 years. Demographic data, Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Patient's satisfactory level were recorded. The radiological evaluation was used to evaluate the implant fixation and complications. Mean followup duration was 5.2 years.
Mean HHS and WOMAC score were significantly ( < 0.05) improved at the last followup. About 98.5% of the patients were satisfied with results of the surgery. All acetabular components were placed in adequate position and there was no osteolysis on acetabular or femoral components and subsidence of femoral stem. Four patients showed complications including one-liner fracture.
Our midterm study demonstrated excellent clinical and radiological results with only one ceramic liner fracture. Moreover, the results of this study indicate that one possible cause of pulling-out phenomenon is the resonance effect during implantation in Dorr type A patients with the thick cortex. If the surgeon is aware of the liner malposition throughout the operation, the fourth-generation CoC articulation THA could be an outstanding treatment.
关于第四代陶瓷对陶瓷（CoC）关节面全髋关节置换术（THA）的结果报告有限。并且，在整个手术过程中，我们遇到了一些在衬垫固定和股骨准备后出现衬垫拔出现象的病例。本研究的目的是评估第四代CoC关节面在THA中使用时，陶瓷衬垫或股骨头骨折的发生率、危险因素，以及临床和影像学结果。
我们回顾性分析了242例患者（263髋），这些患者接受了使用第四代CoC关节面的初次THA，且至少随访2年。记录了人口统计学数据、Harris髋关节评分（HHS）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、患者满意度。通过影像学评估来评估植入物的固定情况和并发症。平均随访时间为5.2年。
在最后一次随访时，平均HHS和WOMAC评分有显著改善（<0.05）。约98.5%的患者对手术结果满意。所有髋臼组件均放置在合适位置，髋臼或股骨组件无骨溶解，股骨柄无下沉。4例患者出现并发症，包括1例衬垫骨折。
我们的中期研究显示，仅有1例陶瓷衬垫骨折，但临床和影像学结果良好。此外，本研究结果表明，拔出现象的一个可能原因是在植入过程中，对于皮质较厚的Dorr A型患者存在共振效应。如果外科医生在整个手术过程中意识到衬垫位置不当，第四代CoC关节面THA可能是一种出色的治疗方法。
