10 至 12 年随访研究：陶瓷对陶瓷全髋关节置换术。
A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty.
机构信息
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
出版信息
Arch Orthop Trauma Surg. 2023 Aug;143(8):5385-5394. doi: 10.1007/s00402-022-04758-x. Epub 2023 Jan 3.
BACKGROUND
We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10 years after surgery.
METHODS
From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7 years (16-83) at surgery were followed for a mean of 10.4 years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints.
RESULTS
There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12 years.
CONCLUSION
During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288).
LEVEL OF EVIDENCE
II (Prospective cohort study).
背景
我们之前报道了使用 delta 陶瓷-陶瓷（CoC）关节的全髋关节置换术（THA）五年至七年的结果。我们进行了一项扩展研究，对术后至少 10 年的患者进行 CT 扫描。
方法
2009 年 3 月至 2011 年 3 月，273 例患者（310 髋）接受了无水泥 THA 联合 delta CoC 关节、多孔涂层杯和羟基磷灰石涂层柄。在这项扩展研究中，252 例患者（144 名男性和 108 名女性）（288 髋），手术时的平均年龄为 49.7 岁（16-83 岁），平均随访 10.4 年（10-12 年），其中 133 髋（46.2%，133/288）进行了 CT 扫描。每次随访时均进行临床和影像学评估，并采用修订和再次手术作为终点进行 Kaplan-Meier 生存分析。
结果
没有更多的陶瓷骨折。与中期结果相比， squeaking 和 RLLs 的发生率分别增加到 3.1%（288 例中有 9 例）和 19.4%（288 例中有 56 例）。3 髋（5.4%，56 例中有 3 例）的 RLL 进展为局限性溶骨。没有髋部出现可检测的磨损或假体松动。2 髋因假体周围关节感染和假体周围股骨骨折各进行了一次翻修手术。12 年后的生存率下降至 98.3%（96.7-99.9%）。
结论
在延长随访期间，未发生额外的陶瓷骨折， squeak 的发生率增加了 0.7%。Delta CoC THA 的长期生存率令人鼓舞。然而，1%（288 例中有 3 例）的羟基磷灰石涂层柄周围发生局限性溶骨。
证据水平
II（前瞻性队列研究）。
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