Miyamoto Shuichi, Iida Satoshi, Suzuki Chiho, Nakatani Takushi, Kawarai Yuya, Nakamura Junichi, Orita Sumihisa, Ohtori Seiji
Department of Orthopaedic Surgery, Matsudo City General Hospital, Matsudo City, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Bone Jt Open. 2021 May;2(5):278-292. doi: 10.1302/2633-1462.25.BJO-2021-0010.R1.
The main aims were to identify risk factors predictive of a radiolucent line (RLL) around the acetabular component with an interface bioactive bone cement (IBBC) technique in the first year after THA, and evaluate whether these risk factors influence the development of RLLs at five and ten years after THA.
A retrospective review was undertaken of 980 primary cemented THAs in 876 patients using cemented acetabular components with the IBBC technique. The outcome variable was any RLLs that could be observed around the acetabular component at the first year after THA. Univariate analyses with univariate logistic regression and multivariate analyses with exact logistic regression were performed to identify risk factors for any RLLs based on radiological classification of hip osteoarthritis.
RLLs were detected in 27.2% of patients one year postoperatively. In multivariate regression analysis controlling for confounders, atrophic osteoarthritis (odds ratio (OR) 2.17 (95% confidence interval (CI), 1.04 to 4.49); p = 0.038) and 26 mm (OR 3.23 (95% CI 1.85 to 5.66); p < 0.001) or 28 mm head diameter (OR 3.64 (95% CI 2.07 to 6.41); p < 0.001) had a significantly greater risk for any RLLs one year after surgery. Structural bone graft (OR 0.19 (95% CI 0.13 to 0.29) p < 0.001) and location of the hip centre within the true acetabular region (OR 0.15 (95% CI 0.09 to 0.24); p < 0.001) were significantly less prognostic. Improvement of the cement-bone interface including complete disappearance and poorly defined RLLs was identified in 15.1% of patients. Kaplan-Meier survival analysis for the acetabular component at ten years with revision of the acetabular component for aseptic loosening as the end point was 100.0% with a RLL and 99.1% without a RLL (95% CI 97.9 to 100). With revision of the acetabular component for any reason as the end point, the survival rate was 99.2% with a RLL (95% CI 97.6 to 100) and 96.5% without a RLL (95% CI 93.4 to 99.7).
This study demonstrates that acetabular bone quality, head diameter, structural bone graft, and hip centre position may influence the presence of the any RLL. Cite this article: 2021;2(5):278-292.
主要目的是确定在全髋关节置换术（THA）后第一年，使用界面生物活性骨水泥（IBBC）技术时，髋臼组件周围出现透亮线（RLL）的预测风险因素，并评估这些风险因素是否会影响THA后五年和十年时RLL的发展。
对876例患者的980例初次骨水泥型THA进行回顾性研究，这些患者使用IBBC技术的骨水泥髋臼组件。结局变量是THA后第一年在髋臼组件周围可观察到的任何RLL。基于髋骨关节炎的放射学分类，进行单因素逻辑回归的单变量分析和精确逻辑回归的多变量分析，以确定任何RLL的风险因素。
术后一年，27.2%的患者检测到RLL。在控制混杂因素的多变量回归分析中，萎缩性骨关节炎（优势比（OR）2.17（95%置信区间（CI），1.04至4.49）；p = 0.038）以及26 mm（OR 3.23（95% CI 1.85至5.66）；p < 0.001）或28 mm的股骨头直径（OR 3.64（95% CI 2.07至6.41）；p < 0.001）在术后一年出现任何RLL的风险显著更高。结构性骨移植（OR 0.19（95% CI 0.13至0.29），p < 0.001）和髋关节中心位于真髋臼区域内（OR 0.15（95% CI 0.09至0.24）；p < 0.001）的预后显著较差。在15.1%的患者中发现骨水泥-骨界面改善，包括完全消失和界限不清的RLL。以无菌性松动翻修髋臼组件为终点，对髋臼组件进行十年的Kaplan-Meier生存分析，有RLL的患者生存率为100.0%，无RLL的患者生存率为99.1%（95% CI 97.9至100）。以任何原因翻修髋臼组件为终点，有RLL的患者生存率为99.2%（95% CI 97.6至100），无RLL的患者生存率为96.5%（95% CI 93.4至99.7）。
本研究表明，髋臼骨质、股骨头直径、结构性骨移植和髋关节中心位置可能会影响任何RLL的出现。引用本文：2021；2(5):278 - 292。
