Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California.
J Arthroplasty. 2024 Feb;39(2):409-415. doi: 10.1016/j.arth.2023.08.025. Epub 2023 Aug 10.
Highly cross-linked polyethylene (HXLPE) acetabular bearing surfaces have appeared to offer excellent wear resistance, low incidence of wear-related osteolysis, and high implant survivorship at 10-year to 15-year follow-up. However, concerns over potential performance deterioration at longer-term follow-up remain - particularly in younger patients - and outcome data into the third decade have not been available.
We retrospectively assessed 62 patients (68 hips) who underwent primary total hip arthroplasty (THA) at age ≤50 years with a single manufacturer's cementless components, remelted HXLPE liner, and small diameter (26 and 28 millimeter) cobalt-chromium (CoCr) femoral heads at minimum 18-year follow-up. We assessed clinical outcomes (modified Harris Hip score, University of California Los Angeles Activity Score, polyethylene wear rates, radiographic findings (osteolysis, component loosening), and implant survivorship.
At 20.6-year mean follow-up (range, 18 to 23 years) modified Harris Hip scores for surviving hips remained an average of 41 points above preoperative baseline (49 versus 90, P < .001) and UCLA scores 2.8 points above baseline (3.7 versus 6.4, P < .001). Wear analysis revealed a population linear wear rate of 0.0142 mm/y (standard deviation (SD), 0.0471) and volumetric wear rate of 10.14 mm/y (SD, 23.41). Acetabular lysis was noted in 2 asymptomatic hips at 16.6 and 18.4 years. No components were radiographically loose. Survivorship free from wear-related revision was 100% at 20 years (97% free from any revision).
The HXLPE-CoCr bearing couple with small femoral heads continues to be extremely effective 20 years after primary THA in the younger patient population.
高度交联聚乙烯（HXLPE）髋臼轴承表面似乎具有出色的耐磨性、低发生率的与磨损相关的骨溶解以及在 10 年至 15 年随访时的高植入物存活率。然而，对于长期随访中潜在性能恶化的担忧仍然存在 - 特别是在年轻患者中 - 并且在第三个十年中还没有可用的结果数据。
我们回顾性评估了 62 名（68 髋）年龄≤50 岁的患者，他们接受了初次全髋关节置换术（THA），使用了单一制造商的无水泥组件、重熔的 HXLPE 衬垫和小直径（26 和 28 毫米）钴铬（CoCr）股骨头，随访时间至少为 18 年。我们评估了临床结果（改良 Harris 髋关节评分、加利福尼亚大学洛杉矶活动评分、聚乙烯磨损率、影像学发现（骨溶解、组件松动）和植入物存活率。
在 20.6 年的平均随访时间（范围为 18 至 23 年），存活髋关节的改良 Harris 髋关节评分平均比术前基线高出 41 分（49 分与 90 分，P<.001），UCLA 评分比基线高出 2.8 分（3.7 分与 6.4 分，P<.001）。磨损分析显示，人群线性磨损率为 0.0142mm/y（标准差（SD）为 0.0471），体积磨损率为 10.14mm/y（SD 为 23.41）。在 16.6 年和 18.4 年时，有 2 个无症状髋出现髋臼溶解。没有任何组件在影像学上松动。20 年时，无因磨损相关翻修的存活率为 100%（无任何翻修的存活率为 97%）。
在年轻患者群体中，初次 THA 后 20 年，HXLPE-CoCr 轴承配合小股骨头仍然非常有效。
