Lewis Peter M, Khan Faiz J, Feathers Jacob R, Lewis Michael H, Morris Keith H, Waddell James P
Prince Charles and Royal Glamorgan Hospitals, Cwm Taf Morgannwg University Health Board, South Wales, UK.
Leeds General Infirmary, Leeds, UK.
Bone Jt Open. 2021 May;2(5):293-300. doi: 10.1302/2633-1462.25.BJO-2021-0006.
"Get It Right First Time" (GIRFT) and NHS England's Best Practice Tariff (BPT) have published directives advising that patients over the ages of 65 (GIRFT) and 69 years (BPT) receiving total hip arthroplasty (THA) should receive cemented implants and have brought in financial penalties if this policy is not observed. Despite this, worldwide, uncemented component use has increased, a situation described as a 'paradox'. GIRFT and BPT do, however, acknowledge more data are required to support this edict with current policies based on the National Joint Registry survivorship and implant costs.
This study compares THA outcomes for over 1,000 uncemented Corail/Pinnacle constructs used in all age groups/patient frailty, under one surgeon, with identical pre- and postoperative pathways over a nine-year period with mean follow-up of five years and two months (range: nine months to nine years and nine months). Implant information, survivorship, and regular postoperative Oxford Hip Scores (OHS) were collected and two comparisons undertaken: a comparison of those aged over 65 years with those 65 and under and a second comparison of those aged 70 years and over with those aged under 70.
Overall revision rate was 1.3% (13/1,004). A greater number of revisions were undertaken in those aged over 65 years, but numbers were small and did not reach significance. The majority of revisions were implant-independent. Single component analysis revealed a 99.9% and 99.6% survival for the uncemented cup and femoral component, respectively. Mean patient-reported outcome measures (PROMs) improvement for all ages outperformed the national PROMs and a significantly greater proportion of those aged over 65/69 years reached and maintained a meaningful improvement in their OHS earlier than their younger counterparts (p < 0.05/0.01 respectively).
This study confirms that this uncemented THA system can be used safely and effectively in patient groups aged over 65 years and those over 69 years, with low complication and revision rates. Cite this article: 2021;2(5):293-300.
“一次做对”（GIRFT）计划和英国国民医疗服务体系（NHS）英格兰地区的最佳实践关税（BPT）已发布指令，建议65岁以上（GIRFT）和69岁以上（BPT）接受全髋关节置换术（THA）的患者应使用骨水泥型植入物，若未遵守该政策将面临经济处罚。尽管如此，在全球范围内，非骨水泥型假体的使用却有所增加，这种情况被描述为一种“悖论”。不过，GIRFT和BPT也承认，需要更多数据来支持这一指令，当前政策是基于国家关节注册中心的生存率和植入物成本制定的。
本研究比较了一位外科医生在九年时间里，对1000多个用于所有年龄组/患者虚弱程度的非骨水泥型Corail/Pinnacle假体进行全髋关节置换术的结果，术前和术后路径相同，平均随访时间为五年零两个月（范围：九个月至九年零九个月）。收集了植入物信息、生存率以及术后定期的牛津髋关节评分（OHS），并进行了两项比较：一项是65岁以上患者与65岁及以下患者的比较，另一项是70岁及以上患者与70岁以下患者的比较。
总体翻修率为1.3%（13/1004）。65岁以上患者的翻修次数更多，但数量较少，未达到统计学显著性。大多数翻修与植入物无关。单组件分析显示，非骨水泥型髋臼杯和股骨组件的生存率分别为99.9%和99.6%。所有年龄组患者报告的平均结局指标（PROMs）改善情况均优于全国水平，且65/69岁以上患者中达到并维持牛津髋关节评分有意义改善的比例明显高于年轻患者（分别为p<0.05/0.01）。
本研究证实，这种非骨水泥型全髋关节置换系统可安全有效地用于65岁以上和69岁以上的患者群体，并发症和翻修率较低。引用本文：2021；2(5):293 - 300。
