Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK.
Department of Trauma and Orthopaedic Surgery, Forth Valley Royal Hospital, Stirling Rd, Larbert, FK5 4WR, UK.
Eur J Orthop Surg Traumatol. 2022 Aug;32(6):1127-1136. doi: 10.1007/s00590-021-03087-w. Epub 2021 Aug 6.
The optimum choice of bearing surfaces in total hip replacement (THR) in the younger and active patient remains controversial. The aim of this study was to report the 10 year clinical outcomes, and a median of 15 year implant survival and incidence of complications in a series of Alumina ceramic-on-ceramic THRs utilising an uncemented shell and cemented stem.
From January 2004 to December 2007, 175 consecutive patients (195 hips) underwent primary THR. The acetabular components was Trident Peripheral Self Locking (Stryker Orthopaedics) with a third-generation ceramic head and liner (Alumina ceramic, Stryker Orthopaedics). The stem utilised was an Exeter V-40 (Stryker Orthopaedics). Data were collated on demographics, surgical factors, clinical outcomes, radiographic outcomes and revision.
23 patients (27 THRs) died during the follow-up period at a median of 7.8 (3.8 to 9.0) years post-operatively due to causes unrelated to the THR. Median age at time of surgery was 55 (interquartile range 48-60) years. Median follow-up for surviving patients was 15.2 years. Survivorship for all-cause revision was 97.2%. Increasing patient age at time of surgery was associated with a higher OHS at 10 years (p = 0.022). 32 mm head diameter had an improved OHS at 3 months (p = 0.014) and 10 years (p = 0.030). Posterior surgical approach had a statistically significant better OHS at 3 months (p = 0.015) and 1 year (p < 0.001), but the effect was not significant at 10 years (p = 0.440).
The findings of this study support excellent long-term outcomes and survivorship of Alumina ceramic-on-ceramic bearing in a hybrid THR in a younger population. Surgical factors leading to a more favourable outcome were the use of a 32 mm femoral head and a posterior approach. Increasing age at surgery demonstrated the most sustained improvement in 10 year clinical outcomes.
在年轻且活跃的患者中，全髋关节置换术（THR）中最佳的轴承表面选择仍存在争议。本研究的目的是报告一系列使用非骨水泥壳和骨水泥柄的氧化铝陶瓷-陶瓷 THR 的 10 年临床结果，以及中位数为 15 年的植入物存活率和并发症发生率。
从 2004 年 1 月至 2007 年 12 月，175 例连续患者（195 髋）接受了初次 THR。髋臼组件为 Trident 外周自锁定（Stryker Orthopaedics），带有第三代陶瓷头和衬垫（氧化铝陶瓷，Stryker Orthopaedics）。使用的柄为 Exeter V-40（Stryker Orthopaedics）。收集了人口统计学、手术因素、临床结果、影像学结果和翻修的数据。
在中位随访 7.8（3.8 至 9.0）年后，23 例（27 例 THR）患者因与 THR 无关的原因死亡。手术时的中位年龄为 55 岁（四分位距 48-60 岁）。存活患者的中位随访时间为 15.2 年。全因翻修的生存率为 97.2%。手术时患者年龄的增加与 10 年时 OHS 的提高相关（p=0.022）。32mm 头直径在 3 个月（p=0.014）和 10 年（p=0.030）时 OHS 改善更明显。后路手术在 3 个月（p=0.015）和 1 年（p<0.001）时 OHS 有显著改善，但在 10 年时无显著差异（p=0.440）。
本研究结果支持在年轻人群中，混合 THR 中氧化铝陶瓷-陶瓷轴承具有优异的长期结果和生存率。导致更有利结果的手术因素是使用 32mm 股骨头和后路入路。手术时年龄的增加显示出 10 年临床结果的持续改善。
