巨头之战：对各国登记处使用的3种最常见非骨水泥型股骨柄进行的生存分析。
Battle of the titans: Survivorship analysis of the 3 most common types of uncemented femoral stems used across national registries.
作者信息
Davey Martin S, Doyle Tom R, Murphy Evelyn, Fenelon Christopher, Murphy Colin G, Cassar-Gheiti Adrian J
机构信息
Royal College of Surgeons in Ireland, Dublin, Ireland.
Galway University Hospitals, Galway, Ireland.
出版信息
J Orthop. 2023 Jul 21;43:41-47. doi: 10.1016/j.jor.2023.07.010. eCollection 2023 Sep.
BACKGROUND
Although many institutions utilize uncemented stems as routine in performing total hip arthroplasty (THA), many surgeons continue to rely on outcomes reported in the literature in the form of small cohorts and patient series when analyzing survivorship for specific implants. The purpose of this study was to identify and analyze the survivorship of the 3 most common uncemented stem types (as opposed to brands) used across multiple national joint registries.
METHODS
A review of data available from all national joint registries was carried out in July 2022. Analysis of each individual registry and classified uncemented implants into the seven different uncemented stem types. The 3 most common stem types were identified, and average cumulative revision rates calculated. Metal on metal bearings surface implants were excluded from this study due to high revision rates across all implant types.
RESULTS
Our detailed review identified 6 out of 13 (NJR, AOANJRR, LROI, EPRD, MARCQI and the NZJR) international registries reporting implant specific survivorship on uncemented femoral stems; including 960,328 uncemented stems across all registries. The most common type of stem used was type 3c, accounting for 61% (583,724), followed by type 1 stems with 23% (217,897) and type 2 stems with 8% (79,257). Cumulative revision rates at 13 years follow-up for these stems ranged from 6.9% to 7.9%.
CONCLUSION
Although all stem types have comparable revision rates across all registries, the most common uncemented stem reported was the type 3c, tapered rectangular fully coated stem. Furthermore, out of all type 3c, the Müller design philosophy with full hydroxyapatite coating seems to be the most sought after worldwide. In this study we can conclude, thus far, that there does not appear to clinical or statistical differences in revision rates between the different stem types
LEVEL OF EVIDENCE
III.
背景
尽管许多机构在进行全髋关节置换术（THA）时常规使用非骨水泥型股骨柄，但许多外科医生在分析特定植入物的生存率时，仍继续依赖以小队列和患者系列形式呈现的文献报道结果。本研究的目的是识别和分析多个国家关节登记处使用的3种最常见的非骨水泥型股骨柄类型（而非品牌）的生存率。
方法
2022年7月对所有国家关节登记处的可用数据进行了回顾。对每个单独的登记处进行分析，并将非骨水泥型植入物分类为七种不同的非骨水泥型股骨柄类型。确定了3种最常见的股骨柄类型，并计算了平均累积翻修率。由于所有植入物类型的翻修率都很高，本研究排除了金属对金属轴承表面植入物。
结果
我们的详细回顾发现，13个国际登记处（NJR、AOANJRR、LROI、EPRD、MARCQI和NZJR）中有6个报告了非骨水泥型股骨柄的特定植入物生存率；所有登记处共有960328个非骨水泥型股骨柄。使用最多的股骨柄类型是3c型，占61%（583724个），其次是1型股骨柄，占23%（217897个），2型股骨柄占8%（79257个）。这些股骨柄在13年随访时的累积翻修率在6.9%至7.9%之间。
结论
尽管所有股骨柄类型在所有登记处的翻修率相当，但报告最多的非骨水泥型股骨柄是3c型，即锥形矩形全涂层股骨柄。此外，在所有3c型中，采用全羟基磷灰石涂层的 Müller设计理念似乎在全球最受欢迎。在本研究中，我们可以得出结论，到目前为止，不同股骨柄类型之间的翻修率在临床或统计学上似乎没有差异。
证据水平
III级。
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