Kumar Narinder, Gabbe Belinda J, Page Richard S, Soh Sze-Ee, Gill David R J, Harries Dylan, Ackerman Ilana N
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
St John of God Hospital and Barwon Health, Geelong, Victoria, Australia.
J Bone Joint Surg Am. 2024 Nov 20;106(22):2085-2093. doi: 10.2106/JBJS.24.00072. Epub 2024 Sep 6.
Population-level data from national arthroplasty registries enable the use and outcomes of arthroplasty procedures to be monitored over time. This study aimed to describe the demographics, indications, and outcomes (up to 15 years) for radial head arthroplasty (RHA) procedures in Australia, as well as the factors associated with an increased likelihood of revision.
Individual-level deidentified data on demographics and surgery characteristics, including revision surgery, were obtained from the Australian Orthopaedic Association National Joint Replacement Registry for all primary isolated RHA procedures that had been performed from 2007 to 2021. The probability of prosthesis survival was determined using Kaplan-Meier estimates. Cox proportional hazards models were used to calculate hazard ratios (HRs) for revision.
A total of 3,457 primary RHAs were performed during the study period (mean follow-up, 5.6 years; range, 0 to 15 years). The mean age at the time of RHA was 53 years, with female predominance (n = 2,009, 58%). The most common indication for RHA was fracture or dislocation (n = 3,166, 92%), followed by osteoarthritis (n = 232, 7%). The radial head prostheses that were most commonly used were monopolar (n = 3,378, 98%) with a modular design (n = 3,442, 99.6%) and cementless fixation (n = 3,387, 98%). Both metallic and nonmetallic prostheses were used (52% and 48%, respectively). Of the total cohort, 160 revisions (5%) were performed during the 15-year period; most revisions occurred in the first 5 years. The most common revision indication was prosthesis loosening (n = 62, 39%), and 54% of the revisions (n = 87) involved a change of the radial component. In multivariable analysis, primary procedures for osteoarthritis (HR, 1.65; 95% confidence interval [CI], 1.01 to 2.70) or "other" indications (e.g., inflammatory arthritis, osteonecrosis, or tumor) were revised more frequently (HR, 3.68; 95% CI, 1.14 to 11.91) than procedures for fracture or dislocation. Procedures with nonmetallic prostheses had higher rates of revision (HR, 1.61; 95% CI, 1.17 to 2.22) than those with metallic prostheses.
Trauma remained the most prevalent indication for RHA in Australia from 2007 to 2021. Encouragingly, revision rates were low, most notably for RHA that had been performed for fracture or dislocation. The likelihood of revision was highest for RHA procedures performed for osteoarthritis and for an indication other than osteoarthritis or trauma. Nonmetallic prostheses had a higher rate of revision than metallic prostheses.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
来自国家关节成形术登记处的人群水平数据能够对关节成形术的使用情况及结果进行长期监测。本研究旨在描述澳大利亚桡骨头置换术（RHA）的人口统计学特征、适应证及长达15年的结果，以及与翻修可能性增加相关的因素。
从澳大利亚骨科协会国家关节置换登记处获取了2007年至2021年期间所有初次孤立RHA手术的个体水平的匿名数据，包括人口统计学和手术特征，以及翻修手术情况。使用Kaplan-Meier估计法确定假体存活概率。采用Cox比例风险模型计算翻修的风险比（HR）。
研究期间共进行了3457例初次RHA手术（平均随访5.6年；范围0至15年）。RHA手术时的平均年龄为53岁，女性居多（n = 2009，58%）。RHA最常见的适应证是骨折或脱位（n = 3166，92%），其次是骨关节炎（n = 232，7%）。最常用的桡骨头假体是单极的（n = 3378，98%），采用模块化设计（n = 3442，99.6%）且为非骨水泥固定（n = 3387，98%）。金属和非金属假体均有使用（分别为52%和48%）。在整个队列中，15年期间进行了160次翻修（5%）；大多数翻修发生在头5年。最常见的翻修适应证是假体松动（n = 62，39%），54%的翻修（n = 87）涉及桡骨部件的更换。在多变量分析中，骨关节炎（HR，1.65；95%置信区间[CI]，1.01至2.70）或“其他”适应证（如炎性关节炎、骨坏死或肿瘤）的初次手术比骨折或脱位的手术更频繁地进行翻修（HR，3.68；95%CI，1.14至11.91）。使用非金属假体的手术比使用金属假体的手术有更高的翻修率（HR，1.61；95%CI，1.17至2.22）。
2007年至2021年期间，创伤仍然是澳大利亚RHA最普遍的适应证。令人鼓舞的是，翻修率较低，尤其是因骨折或脱位而进行的RHA。因骨关节炎以及骨关节炎或创伤以外的适应证进行的RHA手术翻修可能性最高。非金属假体的翻修率高于金属假体。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
