Xpert Clinics Orthopedie Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Hip Int. 2023 Mar;33(2):280-287. doi: 10.1177/11207000211064975. Epub 2022 Jan 2.
The influence of bearing on short-term revision in press-fit total hip arthroplasty (THA) remains under-reported. The aim of this study was to describe 2-year cup revision rates of ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoPE).
Primary press-fit THAs with one of the three most used cups available with both CoC or CoPE bearing recorded in the Dutch Arthroplasty Register (LROI) were included (2007-2019). Primary outcome was 2-year cup revision for all reasons. Secondary outcomes were: reasons for revision, incidence of different revision procedures and use of both bearings over time.
2-year Kaplan-Meier cup revision rate in 33,454 THAs (12,535 CoC; 20,919 CoPE) showed a higher rate in CoC (0.67% [95% CI, 0.54-0.81]) compared to CoPE (0.44% [95% CI, 0.34-0.54]) ( = 0.004). Correction for confounders (age, gender, cup type, head size) resulted in a hazard ratio (HR) of 0.64 [95%CI, 0.48-0.87] ( = 0.019). Reasons for cup revision differed only by more cup revision due to loosening in CoC (26.2% vs.1 3.2%) ( = 0.030). For aseptic loosening a revision rate of 0.153% [95% CI, 0.075-0.231] was seen in CoC and 0.058% [95%CI 0.019-0.097] in CoPE ( = 0.007). Correction for head size resulted in a HR of 0.475 [95% CI, 0.197-1.141] ( = 0.096). Incidence of different revision procedures did not differ between bearings. Over time the use of CoPE has increased and CoC decreased.
A higher 2-year cup revision rate in press-fit THA was observed in CoC compared to CoPE. Cup loosening was the only significantly different reason for revision and seen more often in CoC and mostly aseptic. Future randomised controlled trials need to confirm causality, since the early cup revision data provided has the potential to be useful when choosing the bearing in press-fit THA, when combined with other factors like bone quality and patient and implant characteristics.
压配型全髋关节置换术（THA）中内衬对短期翻修的影响报道较少。本研究旨在描述陶瓷对陶瓷（CoC）和陶瓷对聚乙烯（CoPE）内衬的 2 年杯体翻修率。
本研究纳入了荷兰关节置换注册中心（LROI）中记录的三种最常用杯体之一的初次压配型 THA（2007-2019 年），且这些杯体均有 CoC 或 CoPE 内衬。主要结局为所有原因导致的 2 年杯体翻修。次要结局为：翻修原因、不同翻修手术的发生率以及两种内衬随时间的使用情况。
33454 例 THA 的 2 年 Kaplan-Meier 杯体翻修率显示，CoC（0.67%[95%CI，0.54-0.81]）的翻修率高于 CoPE（0.44%[95%CI，0.34-0.54]）（P=0.004）。对年龄、性别、杯体类型、头大小等混杂因素进行校正后，风险比（HR）为 0.64[95%CI，0.48-0.87]（P=0.019）。翻修原因仅因 CoC 组中因松动而导致更多的杯体翻修（26.2%比 13.2%）而不同（P=0.030）。对于无菌性松动，CoC 的翻修率为 0.153%[95%CI，0.075-0.231]，CoPE 为 0.058%[95%CI，0.019-0.097]（P=0.007）。对头大小进行校正后，HR 为 0.475[95%CI，0.197-1.141]（P=0.096）。两种内衬之间不同翻修手术的发生率无差异。随着时间的推移，CoPE 的使用增加，CoC 的使用减少。
与 CoPE 相比，CoC 组在初次压配型 THA 中 2 年杯体翻修率更高。杯体松动是唯一明显不同的翻修原因，且在 CoC 中更为常见，主要为无菌性松动。需要进一步的随机对照试验来确认其因果关系，因为早期的杯体翻修数据在结合骨质量和患者及植入物特征等其他因素选择压配型 THA 的内衬时可能具有重要意义。
