Gwynne-Jones David P, Memon Adeel
Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand.
Arthroplast Today. 2020 Jun 12;6(3):354-359. doi: 10.1016/j.artd.2020.04.016. eCollection 2020 Sep.
There are a number of reports of polyethylene liner dissociation of third-generation modular acetabular components. This study compares our experience with 2 contemporary systems to determine whether this is an implant- or class-specific problem.
This is a single-center retrospective study of 961 primary total hip arthroplasties using 2 third-generation modular cementless acetabular shells: Pinnacle (535) and R3 (426) with a polyethylene liner. Details of all revisions were obtained from local databases and the New Zealand Joint Registry. Kaplan-Meier survival curves were calculated for all-cause revision, acetabular reoperation (including liner exchange), and liner dissociation.
There were 17 revisions in group 1 (Pinnacle; DePuy Synthes): 17 for recurrent dislocation, 6 for liner dissociations (1.12%), 3 for femoral loosening, and one for deep infection. In group 2 (R3; Smith and Nephew), there were 4 revision procedures: one for infection, 2 for dislocation, and one femoral revision for periprosthetic fracture. There were significantly higher proportions revised in group 1 for all-cause revision, acetabular reoperation, and dissociation ( = .024 to 0.038). The 7-year survival for all-cause revision was 96.1% for Pinnacle and 99.0% for R3 ( = .022), and that in the acetabular reoperation group was 96.9% for Pinnacle and 99.3% for R3 ( = .035).
There was a higher revision rate for the Pinnacle acetabular component than for the R3 at 7 years. This was mainly due to polyethylene liner dissociation that can occur early or late. It appears to be a problem specific to the Pinnacle cup design rather than a feature of similar third-generation acetabular components.
有许多关于第三代模块化髋臼组件聚乙烯衬垫分离的报道。本研究比较了我们使用两种当代系统的经验，以确定这是特定植入物还是特定类型的问题。
这是一项单中心回顾性研究，对961例使用两种第三代无水泥模块化髋臼杯（Pinnacle，535例；R3，426例）及聚乙烯衬垫的初次全髋关节置换术进行研究。所有翻修的详细信息均从本地数据库和新西兰关节登记处获取。计算全因翻修、髋臼再次手术（包括衬垫更换）和衬垫分离的Kaplan-Meier生存曲线。
第1组（Pinnacle；DePuy Synthes）有17例翻修：17例因复发性脱位，6例因衬垫分离（1.12%），3例因股骨松动，1例因深部感染。第2组（R3；Smith and Nephew）有4例翻修手术：1例因感染，2例因脱位，1例因假体周围骨折进行股骨翻修。第1组在全因翻修、髋臼再次手术和分离方面的翻修比例显著更高（P = 0.024至0.038）。Pinnacle全因翻修的7年生存率为96.1%，R3为99.0%（P = 0.022），髋臼再次手术组中，Pinnacle为96.9%，R3为99.3%（P = 0.035）。
7年时，Pinnacle髋臼组件的翻修率高于R3。这主要是由于聚乙烯衬垫分离，其可早可晚发生。这似乎是Pinnacle髋臼杯设计特有的问题，而非类似第三代髋臼组件的共性。
