English Robert Tr, Munro Jacob T, Monk Andrew P
Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.
University of Auckland, New Zealand.
Hip Int. 2024 Jan;34(1):66-73. doi: 10.1177/11207000231210487. Epub 2023 Nov 6.
The use of larger femoral heads in total hip replacement (THR) has increased over the last decade. While the relationship between increasing head size and increased stability is well known, the risk of revision with increasing head size remains poorly understood. The aim of this study was to compare the outcome of total hip joint replacement with 32-mm and 36-mm heads.
We carried out a 20-year retrospective analysis of prospective data from the New Zealand Joint Registry (NZJR). All primary total hip replacements registered between January 1999 and December 2018 were included. We compared the rate of revision of 32-mm and 36-mm heads in THR. Sub-group analysis included comparisons of bearing type and all-cause revision.
60,051 primary THRs met our inclusion criteria. The revision rate per 100 component years was significantly higher with a 36-mm head than with a 32-mm head (0.649 vs. 0.534, 0.001). Subgroup analysis of bearing type showed no significant differences in revision rates for all combinations of 36-mm heads when compared to 32-mm ( 0.074-0.92), with the exception of metal-on-metal (MoM); 0.038. When MoM was removed there was no significant difference in revision rates per 100 component years between 32-mm and 36-mm heads, 0.528 versus 0.578 ( 0.099).
Increasing head size from 32 mm to 36 mm results in no significant increase in revision in all bearing combinations except MoM.
在过去十年中，全髋关节置换术（THR）中使用更大尺寸股骨头的情况有所增加。虽然股骨头尺寸增加与稳定性提高之间的关系已为人熟知，但随着股骨头尺寸增加而进行翻修的风险仍知之甚少。本研究的目的是比较使用32毫米和36毫米股骨头进行全髋关节置换的结果。
我们对来自新西兰关节注册中心（NZJR）的前瞻性数据进行了为期20年的回顾性分析。纳入了1999年1月至2018年12月期间登记的所有初次全髋关节置换病例。我们比较了THR中32毫米和36毫米股骨头的翻修率。亚组分析包括对轴承类型和全因翻修的比较。
60,051例初次THR符合我们的纳入标准。每100个组件年的翻修率，36毫米股骨头显著高于32毫米股骨头（0.649对0.534，P = 0.001）。轴承类型的亚组分析显示，与32毫米相比，36毫米股骨头所有组合的翻修率无显著差异（0.074 - 0.92），金属对金属（MoM）轴承除外；P = 0.038。去除MoM后，32毫米和36毫米股骨头每100个组件年的翻修率无显著差异，分别为0.528和0.578（P = 0.099）。
除MoM外，将股骨头尺寸从32毫米增加到36毫米不会导致所有轴承组合的翻修率显著增加。
