Melbourne Orthopedic Group, Melbourne, Victoria, Australia.
Monash University, Melbourne, Australia.
Bone Joint J. 2023 Sep 1;105-B(9):946-952. doi: 10.1302/0301-620X.105B9.BJJ-2022-0713.R2.
The Birmingham Hip Resurfacing (BHR) arthroplasty has been used as a surgical treatment of coxarthrosis since 1997. We present 20-year results of 234 consecutive BHRs performed in our unit.
Between 1999 and 2001, there were 217 patients: 142 males (65.4%), mean age 52 years (18 to 68) who had 234 implants (17 bilateral). They had patient-reported outcome measures collected, imaging (radiograph and ultrasound), and serum metal ion assessment. Survivorship analysis was performed using Kaplan-Meier estimates. Revision for any cause was considered as an endpoint for the analysis.
Mean follow-up was 20.9 years (19.3 to 22.4). Registry data revealed that 19 hips (8.1%) had been revised and 26 patients (12%) had died from causes unrelated to the BHR. Among the remaining 189 hips, 61% were available for clinical follow-up at 20 years (n = 115) and 70% of patients had biochemical follow-up (n = 132). The cumulative implant survival rate at 20 years for male patients was 96.5% (95% confidence interval (CI) 93.5 to 99.6), and for female patients 87% (95% CI 79.7 to 94.9). The difference was statistically significant (p = 0.029). The mean Oxford Hip Score, Hip disability and Osteoarthritis Outcome Score, and Forgotten Joint Score were 45 (29 to 48), 89 (43 to 100), and 84 (19 to 100), respectively. The mean scores for each of the five domains of the EuroQol five-dimension three-level questionnaire were 1.2, 1.0, 1.2, 1.3, and 1.1, and mean overall score 82.6 (50 to 100). Ultrasound showed no pseudotumour. Mean cobalt and chromium levels were 32.1 nmol/l (1 to 374) and 45.5 nmol/l (9 to 408), respectively.
This study shows that BHRs provide excellent survivorship and functional outcomes in young male patients. At 20 years, soft-tissue imaging and serum metal ion studies suggest that a metal-on-metal resurfacing implant can be well tolerated in a group of young patients.
Birmingham Hip Resurfacing（BHR）关节成形术自 1997 年以来已被用作髋关节骨关节炎的手术治疗方法。我们报告了在我们单位进行的 234 例连续 BHR 的 20 年结果。
1999 年至 2001 年期间，有 217 名患者（142 名男性，65.4%），平均年龄 52 岁（18 至 68 岁），接受了 234 个植入物（17 个双侧）。收集了患者报告的结果测量、影像学（射线照相和超声）和血清金属离子评估。使用 Kaplan-Meier 估计进行生存分析。任何原因的翻修为分析的终点。
平均随访 20.9 年（19.3 至 22.4）。注册数据显示，19 个髋关节（8.1%）进行了翻修，26 名患者（12%）因与 BHR 无关的原因死亡。在其余 189 个髋关节中，61%（n=115）可进行 20 年的临床随访，70%（n=132）的患者可进行生化随访。20 年时男性患者的植入物累积存活率为 96.5%（95%置信区间（CI）93.5 至 99.6），女性患者为 87%（95%CI 79.7 至 94.9）。差异具有统计学意义（p=0.029）。Oxford 髋关节评分、髋关节残疾和骨关节炎结果评分以及被遗忘关节评分的平均值分别为 45（29 至 48）、89（43 至 100）和 84（19 至 100）。EuroQol 五维三级问卷五个领域的平均得分分别为 1.2、1.0、1.2、1.3 和 1.1，总得分平均值为 82.6（50 至 100）。超声未显示假瘤。钴和铬的平均水平分别为 32.1nmol/L（1 至 374）和 45.5nmol/L（9 至 408）。
本研究表明，BHR 为年轻男性患者提供了优异的生存率和功能结果。20 年后，软组织影像学和血清金属离子研究表明，金属对金属表面置换植入物可在一组年轻患者中得到良好耐受。
