Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.
J Arthroplasty. 2020 Oct;35(10):2931-2937. doi: 10.1016/j.arth.2020.05.049. Epub 2020 May 28.
It is proposed that highly porous coatings on acetabular components, such as a porous tantalum coating, provide adequate fixation without ancillary screw fixation in primary total hip arthroplasty (THA). However, tantalum acetabular components have been associated with higher rates of revision than other uncemented components in national registries. The aim of this randomized controlled trial is to determine whether the early migration of a solid-backed tantalum acetabular component was no greater than that of a titanium acetabular component with ancillary screw fixation that has proven good clinical results.
Sixty-six patients aged 40 to 64 years, with osteoarthritis and Charnley grade A or B activity grade and who underwent primary THA, were recruited into the trial. Patients were randomized intraoperatively to receive either the tantalum or titanium acetabular component. All patients received the same cemented polished tapered femoral stem, 28-mm cobalt-chromium femoral head, and highly cross-linked polyethylene liner. Acetabular component migration was measured using radiostereometric analysis at 4-6 days postoperatively and at 6 weeks, 3 months, 1 and 2 years following THA.
The mean proximal migration at 2 years for the tantalum cohort was 0.17 mm (95% confidence interval, 0.09-0.24) which was no greater than that of the titanium cohort which was 0.19 mm (0.07-0.32). Harris hip scores and functional activity scores were similar between groups.
These results demonstrate that early stability can be achieved without ancillary screw fixation through the use of a highly porous high friction coating on a solid-backed modular acetabular component.
Level I.
有人提出，髋臼部件（如多孔钽涂层）上的高多孔涂层在初次全髋关节置换术（THA）中提供足够的固定，而无需辅助螺钉固定。然而，在国家注册中心，钽髋臼部件与更高的翻修率相关，而不是其他非骨水泥部件。本随机对照试验的目的是确定具有辅助螺钉固定的实心背多孔钽髋臼部件的早期迁移是否不比具有良好临床结果的钛髋臼部件的辅助螺钉固定更大。
66 名年龄在 40 至 64 岁之间、患有骨关节炎且 Charnley 分级为 A 或 B 活动度分级的患者入选本试验。患者在术中随机接受钽或钛髋臼部件。所有患者均接受相同的骨水泥抛光锥形股骨柄、28 毫米钴铬股骨头和高度交联聚乙烯衬垫。术后 4-6 天及 THA 后 6 周、3 个月、1 年和 2 年时，使用放射立体测量分析测量髋臼部件的迁移。
在 2 年时，钽组的近端迁移平均值为 0.17 毫米（95%置信区间，0.09-0.24），小于钛组的 0.19 毫米（0.07-0.32）。两组的 Harris 髋关节评分和功能活动评分相似。
这些结果表明，通过使用实心背模块化髋臼部件上的高多孔高摩擦涂层，可以在不使用辅助螺钉固定的情况下实现早期稳定性。
I 级。
