Health Education North East, Newcastle upon Tyne, UK.
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Bone Joint J. 2023 Aug 1;105-B(8):864-871. doi: 10.1302/0301-620X.105B8.BJJ-2022-1150.R3.
Several different designs of hemiarthroplasty are used to treat intracapsular fractures of the proximal femur, with large variations in costs. No clinical benefit of modular over monoblock designs has been reported in the literature. Long-term data are lacking. The aim of this study was to report the ten-year implant survival of commonly used designs of hemiarthroplasty.
Patients recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) between 1 September 1999 and 31 December 2020 who underwent hemiarthroplasty for the treatment of a hip fracture with the following implants were included: a cemented monoblock Exeter Trauma Stem (ETS), cemented Exeter V40 with a bipolar head, a monoblock Thompsons prosthesis (Cobalt/Chromium or Titanium), and an Exeter V40 with a Unitrax head. Overall and age-defined cumulative revision rates were compared over the ten years following surgery.
A total of 41,949 hemiarthroplasties were included. Exeter V40 with a Unitrax head was the most commonly used (n = 20,707, 49.4%). The overall rate of revision was small. A total of 28,201 patients (67.2%) were aged > 80 years. There were no significant differences in revision rates across all designs of hemiarthroplasty in patients of this age at any time. The revision rates for all designs were < 3.5%, three years postoperatively. At subsequent times the ETS and Exeter V40 with a bipolar head performed well in all age groups. The unadjusted ten-year mortality rate for the whole cohort was 82.2%.
There was no difference in implant survival between all the designs of hemiarthroplasty in the first three years following surgery, supporting the selection of a cost-effective design of hemiarthroplasty for most patients with an intracapsular fracture of the hip, as determined by local availability and costs. Beyond this, the ETS and Exeter bipolar designs performed well in all age groups.
为治疗股骨近端囊内骨折，使用了多种不同设计的半髋关节置换术，其成本差异较大。文献中并未报道模块式设计比一体式设计具有临床优势。缺乏长期数据。本研究旨在报告常用半髋关节置换术设计的十年植入物存活率。
纳入了澳大利亚矫形协会全国关节置换登记处（AOANJRR）在 1999 年 9 月 1 日至 2020 年 12 月 31 日期间记录的因髋部骨折接受半髋关节置换术治疗的患者，这些患者使用了以下植入物：骨水泥固定的一体式 Exeter Trauma Stem（ETS）、带双极头的骨水泥固定 Exeter V40、一体式 Thompsons 假体（钴铬或钛）和带 Unitrax 头的 Exeter V40。比较了手术后十年内的总体和年龄定义的累计翻修率。
共纳入 41949 例半髋关节置换术。带 Unitrax 头的 Exeter V40 是最常用的（n=20707，49.4%）。总的翻修率很小。共有 28201 名患者（67.2%）年龄>80 岁。在任何时候，在这个年龄段的所有患者中，各种半髋关节置换术设计的翻修率均无显著差异。所有设计的翻修率在术后三年内均<3.5%。随后，在所有年龄段中，ETS 和带双极头的 Exeter V40 表现良好。整个队列的未调整十年死亡率为 82.2%。
在手术后的前三年，所有半髋关节置换术设计的植入物存活率没有差异，支持根据当地可用性和成本选择一种经济有效的半髋关节置换术设计，用于大多数髋关节囊内骨折患者。在此之后，ETS 和 Exeter 双极设计在所有年龄组中表现良好。
