Tsikandylakis Georgios, Overgaard Soren, Zagra Luigi, Kärrholm Johan
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
Region Västra Götaland, Sahlgrenska University Hospital, Department of Orthopaedics, Gothenburg, Sweden.
EFORT Open Rev. 2020 Oct 26;5(10):763-775. doi: 10.1302/2058-5241.5.200002. eCollection 2020 Oct.
Choice of articulating materials, head size and the design of the articulation will become decisive for the long-term performance of a total hip arthroplasty (THA) and especially in terms of risk for dislocation and wear-related problems. Here we account for common alternatives based on available studies and the evidence that can be derived from them.Metal or ceramic femoral heads articulating against a liner or cup made of highly cross-linked polyethylene and ceramic-on-ceramic articulations have about similar risk for complications leading to revision, whereas the performance of metal-on-metal articulations, especially with use of big heads, is inferior. The clinical significance of problems related to ceramic-on-ceramic articulations such as squeaking remains unclear. With use of current technology ceramic fractures are rare.Large femoral heads have the potential to increase the range of hip movement before impingement occurs and are therefore expected to reduce dislocation rates. On the other hand, issues related to bearing wear, corrosion at the taper-trunnion junction and groin pain may arise with larger heads and jeopardize the longevity of THA. Based on current knowledge, 32-mm heads seem to be optimal for metal-on-polyethylene bearings. Patients with ceramic-on-ceramic bearings may benefit from even larger heads such as 36 or 40 mm, but so far there are no long-term reports that confirm the safety of bearings larger than 36 mm.Assessment of lipped liners is difficult because randomized studies are lacking, but retrospective clinical studies and registry data seem to indicate that this liner modification will reduce the rate of dislocation or revision due to dislocation without clear evidence of clinically obvious problems due to neck-liner impingement.The majority of studies support the view that constrained liners and dual mobility cups (DMC) will reduce the risk of revision due to dislocation both in primary and revision THA, the latter gaining increasing popularity in some countries. Both these devices suffer from implant-specific problems, which seem to be more common for the constrained liner designs. The majority of studies of these implants suffer from various methodological problems, not least selection bias, which calls for randomized studies preferably in a multi-centre setting to obtain sufficient power. In the 2020s, the orthopaedic profession should place more effort on such studies, as has already been achieved within other medical specialties, to improve the level of evidence in the choice of articulation when performing one of the most common in-hospital surgical procedures in Europe. Cite this article: 2020;5:763-775. DOI: 10.1302/2058-5241.5.200002.
关节连接材料的选择、股骨头大小以及关节连接设计对于全髋关节置换术（THA）的长期性能将起到决定性作用，尤其是在脱位风险和磨损相关问题方面。在此，我们根据现有研究及从中得出的证据阐述常见的选择。金属或陶瓷股骨头与由高度交联聚乙烯制成的内衬或髋臼杯相连接，以及陶瓷对陶瓷关节连接导致翻修的并发症风险大致相似，而金属对金属关节连接的性能，尤其是使用大头时，较差。与陶瓷对陶瓷关节连接相关的问题（如摩擦音）的临床意义仍不明确。采用当前技术，陶瓷骨折很少见。大尺寸股骨头有可能在撞击发生前增加髋关节活动范围，因此有望降低脱位率。另一方面，大尺寸股骨头可能会出现与轴承磨损、锥度 - 耳轴连接处腐蚀以及腹股沟疼痛相关的问题，并危及全髋关节置换术的使用寿命。基于目前的认知，32毫米的股骨头似乎是金属对聚乙烯轴承的最佳选择。使用陶瓷对陶瓷轴承的患者可能会从更大尺寸的股骨头（如36或40毫米）中受益，但到目前为止，尚无长期报告证实大于36毫米的轴承的安全性。由于缺乏随机研究，对带唇缘内衬的评估很困难，但回顾性临床研究和登记数据似乎表明，这种内衬改良将降低脱位率或因脱位导致的翻修率，且没有明确证据表明存在因颈部 - 内衬撞击导致的明显临床问题。大多数研究支持这样的观点，即限制性内衬和双动髋臼杯（DMC）将降低初次和翻修全髋关节置换术中因脱位导致的翻修风险，后者在一些国家越来越受欢迎。这两种装置都存在特定于植入物的问题，对于限制性内衬设计来说似乎更常见。对这些植入物的大多数研究都存在各种方法学问题，尤其是选择偏倚，这就需要进行随机研究，最好是在多中心环境下进行，以获得足够的说服力。在21世纪20年代，骨科专业应像其他医学专科已经做到的那样，在这类研究上投入更多精力，以提高在欧洲最常见的住院手术之一——全髋关节置换术的关节连接选择方面的证据水平。引用本文：2020;5:763 - 775。DOI: 10.1302/2058 - 5241.5.200002。
