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在年轻患者的非骨水泥全髋关节置换术中，压配式髋臼杯的最少 20 年随访结果。

Minimum 20-year follow-up of a press-fit acetabular cup in cementless total hip replacement in young patients.

机构信息

Department of Orthopaedics, Heidelberg University Hospital, Heidelberg.

Diakonie Klinikum Stuttgart.

出版信息

Acta Orthop. 2023 Jul 4;94:321-327. doi: 10.2340/17453674.2023.13385.

DOI:10.2340/17453674.2023.13385
PMID:37409417
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10326741/
Abstract

PURPOSE

We aimed to determine the minimum 20-year survival rates of a cementless press-fit cup in young patients.

PATIENTS AND METHODS

This is a retrospective, single-center, multi-surgeon cohort study investigating the minimum 20-year clinical and radiological outcome of the first 121 consecutive total hip replacements (THRs) using a cementless, press-fit cup (Allofit, Zimmer, Warsaw, IN, USA) performed between 1999 and 2001. 28-mm metal-on-metal (MoM) and ceramic-on-conventionally not highly crosslinked polyethylene (CoP) bearings were used in 71% and 28%, respectively. Median patient age at surgery was 52 (range 21-60) years. Kaplan-Meier survival analysis was conducted for different endpoints.

RESULTS

The 22-year survival rate for the endpoint aseptic cup or inlay revision was 94% (95% confidence interval [CI] 87-96) and 99% (CI 94-100) for aseptic cup loosening. 20 patients (21 THRs; 17%) had died and 5 (5 THRs; 4%) were lost to follow-up. No THR showed evidence of radiographic cup loosening. Osteolysis was observed in 40% of THRs with MoM and 77% with CoP bearings. 88% of THRs with CoP bearings showed significant polyethylene wear.

CONCLUSION

The investigated cementless press-fit cup, which is still in clinical use today, showed excellent long-term survival rates in patients under the age of 60 years at surgery. However, osteolysis due to polyethylene and metal wear was frequently observed and is a matter of concern in the third decade after surgery.

摘要

目的

我们旨在确定年轻患者中无水泥固定压配合杯的最低 20 年生存率。

患者和方法

这是一项回顾性、单中心、多外科医生队列研究，调查了 1999 年至 2001 年间使用无水泥、压配合杯（Allofit，Zimmer，Warsaw，IN，USA）进行的前 121 例连续全髋关节置换术（THR）的最低 20 年临床和放射学结果。71%和 28%分别使用了 28-mm 金属对金属（MoM）和陶瓷对传统非高交联聚乙烯（CoP）轴承。手术时患者的中位年龄为 52 岁（范围 21-60 岁）。进行了不同终点的 Kaplan-Meier 生存分析。

结果

无菌杯或衬垫翻修的 22 年生存率为 94%（95%置信区间 [CI] 87-96），无菌杯松动的生存率为 99%（CI 94-100）。20 名患者（21 例 THR；17%）死亡，5 名患者（5 例 THR；4%）失访。没有 THR 显示出放射性杯松动的证据。MoM 组中有 40%的 THR 和 CoP 组中有 77%的 THR 观察到骨溶解。88%的 CoP 轴承 THR 显示出明显的聚乙烯磨损。

结论

在手术时年龄在 60 岁以下的患者中，研究中使用的无水泥压配合杯显示出优异的长期生存率。然而，由于聚乙烯和金属磨损导致的骨溶解经常被观察到，这是手术后第三十年需要关注的问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/7a83529e1d60/ActaO-94-13385-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/72dafae047f4/ActaO-94-13385-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/6525234c312d/ActaO-94-13385-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/5fffbcf1fe37/ActaO-94-13385-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/616c17e3c85e/ActaO-94-13385-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/156b7de41c45/ActaO-94-13385-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/80759b98acd2/ActaO-94-13385-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/8c32f1cd93bb/ActaO-94-13385-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/afdb7e39e698/ActaO-94-13385-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/7a83529e1d60/ActaO-94-13385-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/72dafae047f4/ActaO-94-13385-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/6525234c312d/ActaO-94-13385-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/5fffbcf1fe37/ActaO-94-13385-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/616c17e3c85e/ActaO-94-13385-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/156b7de41c45/ActaO-94-13385-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/80759b98acd2/ActaO-94-13385-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/8c32f1cd93bb/ActaO-94-13385-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/afdb7e39e698/ActaO-94-13385-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/445d/10326741/7a83529e1d60/ActaO-94-13385-g009.jpg

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