Orthopaedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Clinical Research Support Unit (HUB-IDIBELL: Bellvitge University Hospital & Bellvitge Biomedical Research Institute), Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
Hip Int. 2024 Jul;34(4):467-475. doi: 10.1177/11207000241239624. Epub 2024 Mar 26.
Ceramic-on-ceramic bearings have been widely used since their introduction in the 1970s. First-generation ceramics have very high fracture (breakage) rates. To overcome this, in the 1990s, modular cotyloid insert designs were developed, consisting of a ceramic and polyethylene composite (sandwich-type) liner; however, high implant fracture rates were observed in the medium term. We aimed to estimate the cumulative incidences of revision surgery (implant failure) and implant failure due to fractures, survival rates (time-to-revision surgery and time-to-fracture), and the long-term clinical and radiological outcomes in our series.
This was an observational, longitudinal, ambispective, single-centre study based on patients who underwent primary total hip arthroplasty (THA) using a sandwich-type liner (Cerasul), only available in our tertiary hospital between January 1999 and December 2002. Cumulative incidences were estimated and the 95% confidence interval (95% CI) was calculated. The Kaplan-Meier method was used to assess the time-to-revision surgery and time-to-fracture.
54 patients (49 men) were included, accounting for 59 sandwich-type linear implants. The mean (range) age was 47.4 (22-57) years. The primary THA indications were osteoarthritis (28 patients), osteonecrosis (14), childhood pathology sequelae (11), and inflammatory arthritis (6). The cumulative incidence of revision surgery by implants was 8.5% (5/59, 95% CI, 3.5-19.2%), 9.3% by patients (5/54, 95% CI, 4.0-19.9%), and 5.1% by implant fractures (3/59, 95%CI, 1.7-13.9%). The median (Interquartile Range, IQR) time-to-revision surgery was 158 (72.5-161) months, and the time to fracture was 182 (138-215) months. All primary THAs had good clinical and long-term survival outcomes. All implants had signs of solid fixation.
After a 20-year follow-up period, the polyethylene-ceramic sandwich-type liner showed a long survival rate and low cumulative incidence of implant fracture; however, implant fractures remain the main complication. Orthopaedic surgeons should be aware that some patients still have this type of prosthesis and must be capable of responding quickly if a fracture occurs.
自 20 世纪 70 年代以来，陶瓷对陶瓷轴承已被广泛应用。第一代陶瓷的断裂（破损）率非常高。为了解决这个问题，在 20 世纪 90 年代，开发了模块化杯状插入物设计，由陶瓷和聚乙烯复合材料（三明治型）衬垫组成；然而，在中期观察到高植入物断裂率。我们旨在估计我们系列中翻修手术（植入物失败）和因骨折导致的植入物失败的累积发生率、生存率（翻修手术时间和骨折时间）以及长期临床和影像学结果。
这是一项基于在 1999 年 1 月至 2002 年 12 月期间仅在我们的三级医院使用三明治型衬垫（Cerasul）进行初次全髋关节置换术（THA）的患者的观察性、纵向、前瞻性、单中心研究。估计了累积发生率并计算了 95%置信区间（95%CI）。采用 Kaplan-Meier 法评估翻修手术时间和骨折时间。
54 例患者（49 名男性），共 59 个三明治线性植入物。平均（范围）年龄为 47.4（22-57）岁。初次 THA 的主要适应证为骨关节炎（28 例）、骨坏死（14 例）、儿童病理后遗症（11 例）和炎症性关节炎（6 例）。植入物翻修手术的累积发生率为 8.5%（5/59，95%CI，3.5-19.2%），患者为 9.3%（5/54，95%CI，4.0-19.9%），植入物骨折为 5.1%（3/59，95%CI，1.7-13.9%）。翻修手术时间的中位数（四分位距，IQR）为 158（72.5-161）个月，骨折时间为 182（138-215）个月。所有初次 THA 的临床和长期生存率均良好。所有植入物均有固定良好的迹象。
在 20 年的随访期后，聚乙烯陶瓷三明治衬垫显示出较高的生存率和较低的植入物骨折累积发生率；然而，植入物骨折仍然是主要并发症。骨科医生应该意识到，有些患者仍然有这种类型的假体，如果发生骨折，必须能够迅速做出反应。
