Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Myongji hospital, Hanyang University School of Medicine, Goyang, South Korea.
J Arthroplasty. 2024 Oct;39(10):2536-2541.e1. doi: 10.1016/j.arth.2024.05.021. Epub 2024 May 10.
We previously reported the mean 6-year outcomes of total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) articulations. With extended observations, this study aimed to report the mean 12-year outcomes focusing on bearing-related complications of CoC THA.
We reviewed primary CoC THAs performed between May 2009 and April 2012 at a single institution. Of the 831 hips (739 patients), 716 hips (635 patients) that satisfied a minimum 10-year follow-up were included. The mean age at operation was 54 years (range, 16 to 83). The occurrence of bearing-specific complications, including ceramic fractures and noise generation, was evaluated. The mean follow-up duration was 12 years (range, 10 to 14).
A total of 2 (0.3%) ceramic liner fractures occurred, as previously reported. No additional ceramic fractures were observed during the extended follow-up period. However, the cumulative incidence of audible noise increased from 6.4 (48 of 749) to 8.2% (59 of 716). Of the 59 hips with noise, 26 (44.1%) developed noise within 1 year, whereas 13 (22.0%) presented with noise more than 5 years after THA. The noise was described as clicking in 35 hips (4.9%) and as squeaking in 24 hips (3.4%). No revision surgeries were performed for noise, except in 2 cases of concomitant liner fractures. The implant survivorship free of any revision was 98.1% at 12 years.
No additional ceramic fractures were identified in this extension study at a minimum follow-up of 10 years. However, the prevalence of articular noise has increased from 6.4 to 8.2% since the previous report. Possible late-onset noise should be considered when performing CoC THA in younger patients.
我们之前报告了第四代陶瓷对陶瓷（CoC）关节全髋关节置换术（THA）的平均 6 年结果。随着观察时间的延长，本研究旨在报告平均 12 年的结果，重点关注 CoC-THA 的与轴承相关的并发症。
我们回顾了 2009 年 5 月至 2012 年 4 月在一家机构进行的原发性 CoC-THA。在 831 髋（739 例患者）中，有 716 髋（635 例患者）满足至少 10 年随访要求，纳入本研究。手术时的平均年龄为 54 岁（范围：16 岁至 83 岁）。评估了与轴承相关的并发症的发生情况，包括陶瓷破裂和噪音产生。平均随访时间为 12 年（范围：10 年至 14 年）。
正如之前报道的那样，共有 2 例（0.3%）陶瓷衬里骨折。在延长的随访期间，未观察到其他陶瓷骨折。然而，可闻噪声的累积发生率从 6.4%（749 例中的 48 例）增加到 8.2%（716 例中的 59 例）。在 59 例有噪声的髋关节中，26 例（44.1%）在 1 年内出现噪声，而 13 例（22.0%）在 THA 后 5 年以上出现噪声。35 例（4.9%）的噪声描述为咔哒声，24 例（3.4%）的噪声描述为 squeaking。除了 2 例同时发生衬里骨折的病例外，没有因噪声而进行翻修手术。12 年时无任何翻修的植入物存活率为 98.1%。
在至少 10 年的随访中，本扩展研究未发现其他陶瓷骨折。然而，自上次报告以来，关节噪声的发生率已从 6.4%增加到 8.2%。在为年轻患者进行 CoC-THA 时，应考虑可能出现的迟发性噪声。
