Molloy J, Handford C, Coolican J, Molloy T, Walter W
School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia.
Department of Orthopedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.
JB JS Open Access. 2024 Mar 25;9(1). doi: 10.2106/JBJS.OA.23.00057. eCollection 2024 Jan-Mar.
Hip resurfacing arthroplasty (HRA) provides an attractive alternative to total hip arthroplasty (THA) for the management of osteoarthritis in younger, more active patients; however, concerns persist over complications specific to HRA. The aims of this systematic review were to assess the documented long-term survival rates of the metal-on-metal BIRMINGHAM HIP Resurfacing System at a follow-up of at least 10 years and to analyze the functional outcomes and cause of failures.
A systematic review was undertaken of all published cohort studies available in the MEDLINE, Cochrane, Embase, and PubMed research databases up to December 2021, as recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extraction was focused on survival rates, causes of failure, and functional outcomes. Survival estimates at 10 years were pooled in a meta-analysis, with each series weighted by its variance. Causes of failure were presented as a percentage of the pooled revisions.
A total of 11 studies were identified, encompassing 3,129 cases. Across the 9 studies that had reported a mean follow-up, the mean follow-up was 11.7 years (range, 9.55 to 13.7 years). We found a pooled 10-year survival rate of 95.5% (95% confidence interval, 93.4% to 97.1%). There were 149 revisions among the studies (range, 4 to 38 revisions per study), a rate of 4.8% of the total procedures performed. The 2 main causes of revision were aseptic loosening (20.1% of revisions) and adverse reactions to metal debris (20.1%). There were no revisions for dislocation. Of the studies that reported preoperative functional scores, all reported significant improvement in mean scores postoperatively except for 1 study in which the mean Tegner activity score did not significantly improve.
When performed for appropriate indications, patients undergoing an HRA with use of the BIRMINGHAM HIP Resurfacing System can expect good implant survivorship at 10 years with acceptable functional results and low rates of dislocation and infection. This systematic review, however, confirms concerns regarding adverse reactions to metal debris as a leading cause of revision.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
对于年轻、活动量较大的骨关节炎患者，髋关节表面置换术（HRA）为全髋关节置换术（THA）提供了一种有吸引力的替代方案；然而，人们对HRA特有的并发症仍存在担忧。本系统评价的目的是评估金属对金属的伯明翰髋关节表面置换系统在至少10年随访期内已记录的长期生存率，并分析其功能结果及失败原因。
按照系统评价和Meta分析的首选报告项目指南的建议，对截至2021年12月MEDLINE、Cochrane、Embase和PubMed研究数据库中所有已发表的队列研究进行系统评价。数据提取集中在生存率、失败原因和功能结果方面。10年生存率估计值在Meta分析中进行汇总，每个系列按其方差加权。失败原因以汇总翻修手术的百分比呈现。
共识别出11项研究，涵盖3129例病例。在报告了平均随访时间的9项研究中，平均随访时间为11.7年（范围为9.55至13.7年）。我们发现汇总的10年生存率为95.5%（95%置信区间为93.4%至97.1%）。这些研究中共有149例翻修手术（范围为每项研究4至38例翻修），占所实施手术总数的4.8%。翻修的两个主要原因是无菌性松动（占翻修手术的20.1%）和对金属碎屑的不良反应（20.1%）。没有因脱位而进行的翻修手术。在报告了术前功能评分的研究中，除1项研究的平均特格纳活动评分没有显著改善外，所有研究均报告术后平均评分有显著提高。
当为合适的适应证进行手术时，使用伯明翰髋关节表面置换系统接受HRA的患者在10年时可预期有良好的植入物生存率、可接受的功能结果以及较低的脱位和感染率。然而，本系统评价证实了对金属碎屑不良反应作为翻修主要原因的担忧。
治疗性四级。有关证据水平的完整描述，请参阅作者须知。
