Cheung Amy, Chan Ping Keung, Fu Henry, Cheung Man Hong, Chan Vincent Wai Kwan, Luk Michelle Hilda, Chiu Kwong-Yuen
Department of Orthopaedics and Traumatology, Queen Mary Hospital, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.
Int Orthop. 2023 Oct;47(10):2547-2552. doi: 10.1007/s00264-023-05844-4. Epub 2023 May 29.
Cross-linked polyethylene (PE) has been used with great clinical success in total hip arthroplasty (THA) since its debut in the late 1990's. However, reports regarding this bearing couple near the end of its second decade of service are still scant. The aim of this study was to first determine the long term clinical and radiological results and second Investigate what factors affect wear rates using a metal-on-crosslinked PE bearing articulation.
55 THAs using a single brand of cross-linked liner, cementless cup and 28 mm hip ball were performed in 44 patients. Age, sex, Charlson Comorbidity Index (CCI) and need for revision surgery were recorded. Linear and volumetric wear was determined using the Martell method.
Mean age at operation was 51.2 (29-73 ± 12.1) years. Mean duration of follow-up was 16.9 years (range 15.0-20.1 ± 1.1 years). Osteolysis was not present in the latest follow-up radiographs. Median linear and volumetric wear rate was 0.038 mm/year (95% CI 0.032-0.047) and 7.115mm3/year (95% CI 6.92-17.25) respectively. Acetabular component position was not found to be related to both linear and volumetric wear. No significant difference was found in the linear and volumetric wear rates of thinner and thicker liners (8 mm or below and > 8 mm) (p = 0.849 and p = 0.64 respectively).
Metal-on-crosslinked PE is associated with low linear and volumetric wear rates which has virtually obviated osteolysis and has translated to excellent survivorship even at long term follow up. In-vivo oxidation does not appear to be of clinical concern at this point.
自20世纪90年代末首次亮相以来，交联聚乙烯（PE）在全髋关节置换术（THA）中取得了巨大的临床成功。然而，关于这种轴承组合在其使用第二个十年末期的报告仍然很少。本研究的目的首先是确定长期临床和放射学结果，其次是研究使用金属对交联聚乙烯轴承关节的哪些因素会影响磨损率。
对44例患者进行了55次使用单一品牌交联衬垫、无水泥髋臼杯和28毫米髋关节球头的全髋关节置换术。记录年龄、性别、查尔森合并症指数（CCI）和翻修手术需求。使用马特尔方法确定线性磨损和体积磨损。
手术时的平均年龄为51.2（29 - 73±12.1）岁。平均随访时间为16.9年（范围15.0 - 20.1±1.1年）。最新的随访X光片中未发现骨溶解。线性磨损率和体积磨损率的中位数分别为0.038毫米/年（95%可信区间0.032 - 0.047）和7.115立方毫米/年（95%可信区间6.92 - 17.25）。未发现髋臼组件位置与线性磨损和体积磨损有关。较薄和较厚衬垫（8毫米及以下和>8毫米）的线性磨损率和体积磨损率无显著差异（p分别为0.849和0.64）。
金属对交联聚乙烯的线性磨损率和体积磨损率较低，几乎消除了骨溶解，即使在长期随访中也转化为出色的生存率。目前体内氧化似乎不是临床关注的问题。
