Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pok Fu Lam, Hong Kong.
Department of Orthopaedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Bone Joint J. 2024 May 1;106-B(5 Supple B):59-65. doi: 10.1302/0301-620X.106B5.BJJ-2023-0821.R2.
Isolated acetabular liner exchange with a highly crosslinked polyethylene (HXLPE) component is an option to address polyethylene wear and osteolysis following total hip arthroplasty (THA) in the presence of a well-fixed acetabular shell. The liner can be fixed either with the original locking mechanism or by being cemented within the acetabular component. Whether the method used for fixation of the HXLPE liner has any bearing on the long-term outcomes is still unclear.
Data were retrieved for all patients who underwent isolated acetabular component liner exchange surgery with a HXLPE component in our institute between August 2000 and January 2015. Patients were classified according to the fixation method used (original locking mechanism (n = 36) or cemented (n = 50)). Survival and revision rates were compared. A total of 86 revisions were performed and the mean duration of follow-up was 13 years.
A total of 20 patients (23.3%) had complications, with dislocation alone being the most common (8.1%; 7/86). Ten patients (11.6%) required re-revision surgery. Cementing the HXLPE liner (8.0%; 4/50) had a higher incidence of re-revision due to acetabular component liner-related complications than using the original locking mechanism (0%; 0/36; p = 0.082). Fixation using the original locking mechanism was associated with re-revision due to acetabular component loosening (8.3%; 3/36), compared to cementing (0%; 0/50; p = 0.038). Overall estimated mean survival was 19.2 years. There was no significant difference in the re-revision rate between the original locking mechanism (11.1%; 4/36) and cementing (12.0%; 6/50; p = 0.899). Using Kaplan-Meier survival analysis, the revision-free survival of HXLPE fixed with the original locking mechanism and cementing was 94.1% and 93.2%, respectively, at ten years, and 84.7% and 81.3%, respectively, at 20 years (p = 0.840).
The re-revision rate and the revision-free survival following acetabular component liner exchange revision surgery using the HXLPE liner were not influenced by the fixation technique used. Both techniques were associated with good survival at a mean follow-up of 13 years. Careful patient selection is necessary for isolated acetabular component liner exchange revision surgery in order to achieve the best outcomes.
在髋臼壳固定良好的情况下，对于全髋关节置换术后出现聚乙烯磨损和骨溶解的患者，可选择单独更换髋臼内衬，并使用高交联聚乙烯（HXLPE）。这种内衬可以通过原始锁定机制或通过在髋臼组件内进行水泥固定。目前，仍不清楚固定 HXLPE 衬垫的方法是否会对长期结果产生影响。
我们回顾了 2000 年 8 月至 2015 年 1 月期间我院所有接受单独更换髋臼组件衬垫手术且使用 HXLPE 组件的患者数据。根据使用的固定方法对患者进行分类（原始锁定机制（n=36）或水泥固定（n=50））。比较了生存率和翻修率。共进行了 86 次翻修，平均随访时间为 13 年。
共有 20 名患者（23.3%）出现并发症，其中最常见的是单纯脱位（8.1%；7/86）。10 名患者（11.6%）需要再次翻修手术。水泥固定 HXLPE 衬垫（8.0%；4/50）的髋臼组件衬垫相关并发症导致再次翻修的发生率高于使用原始锁定机制（0%；0/36；p=0.082）。使用原始锁定机制固定与髋臼组件松动导致再次翻修（8.3%；3/36）有关，而水泥固定则没有（0%；0/50；p=0.038）。总体估计平均生存率为 19.2 年。原始锁定机制（11.1%；4/36）和水泥固定（12.0%；6/50；p=0.899）的再次翻修率无显著差异。使用 Kaplan-Meier 生存分析，使用原始锁定机制和水泥固定的 HXLPE 固定的无翻修生存率分别为 10 年时的 94.1%和 93.2%，20 年时分别为 84.7%和 81.3%（p=0.840）。
使用 HXLPE 衬垫进行髋臼组件衬垫翻修手术后，翻修率和无翻修生存率不受固定技术的影响。两种技术在平均随访 13 年后均有良好的生存率。为了获得最佳效果，单独进行髋臼组件衬垫翻修手术时，需要对患者进行仔细选择。
