Wang Xipeng, Liu Jiangtao
Department of Orthopaedic Surgery, the Central Hospital of Wuhan, Tongji Medical College of Huazhong University of Science & Technology, Wuhan Hubei, 430010, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Sep 15;38(9):1079-1085. doi: 10.7507/1002-1892.202403040.
To analyze the occurrence of osteolysis in total hip arthroplasty (THA) with highly cross-linked polyethylene prosthesis during a follow-up of more than 15 years.
The clinical data of 84 patients (105 hips) treated with THA in the Affiliated Hospital of Kanazawa Medical University in Japan between June 2000 and April 2004 and met the selection criteria was retrospectively analyzed. There were 7 males and 77 females, aged from 41 to 75 years, with an average of 56.4 years. There were 94 hips with secondary hip osteoarthritis, 4 hips after pelvic osteotomy, 2 hips with primary hip osteoarthritis, 2 hips with traumatic hip osteoarthritis, 2 hips with osteonecrosis of the femoral head, and 1 hip with rheumatoid arthritis. According to Crowe classification, there were 79 hips of type Ⅰ, 19 hips of type Ⅱ, 6 hips of type Ⅲ, and 1 hip of type Ⅳ. The highly cross-linked polyethylene acetabular liner combined with a 26 mm zirconia femoral head were used in all patients. X-ray films were taken after operation to analyze the radiation transmission and osteolysis around the acetabular prosthesis. The vertical distance (the distance between the teardrop line at the lower edge of the pelvis and the perpendicular line of the hip rotation center), the horizontal distance (the horizontal distance between the hip rotation center and the interteardrop line and the vertical line at the lower edge of the teardrop), and the acetabular cup anteversion angle were measured at last follow-up. The acetabular and femoral osteolysis was analyzed by CT scan and three-dimensional multiplanar reconstruction (3D-MPR). Combined with X-ray film and CT results, osteolysis was evaluated according to the Narkbunnam score.
Deep vein thrombosis of lower limbs occurred in 2 cases. All patients were followed up 15-18 years, with an average of 15.9 years. One hip dislocation and 1 periprosthetic fracture occurred postoperatively, and no acetabular loosening or prosthetic lining ruptures occurred. Except for 1 patient who had a radiolucent line in the acetabulum after operation, the other 83 patients did not show any radiolucent line in the acetabulum or the femur. None of the patients underwent hip revision. X-ray films at last follow-up showed an acetabular cup anteversion angle of -10°-39°, with an average of 22°; a vertical distance of 3.5-47.1 mm, with an average of 24.6 mm; and a horizontal distance of 22.6-48.1 mm, with an average of 31.7 mm. There was no acetabular or femoral osteolysis in all patients on X-ray films and CT 3D-MPR images at last follow-up, and the Narkbunnam score was 0 in any region.
Highly cross-linked polyethylene prosthesis does not increase the risk of long-term complications such as osteolysis after THA.
分析使用高交联聚乙烯假体的全髋关节置换术（THA）在超过15年的随访期内骨溶解的发生情况。
回顾性分析2000年6月至2004年4月间在日本金泽医科大学附属医院接受THA治疗且符合入选标准的84例患者（105髋）的临床资料。其中男性7例，女性77例，年龄41至75岁，平均56.4岁。继发性髋关节骨关节炎94髋，骨盆截骨术后4髋，原发性髋关节骨关节炎2髋，创伤性髋关节骨关节炎2髋，股骨头坏死2髋，类风湿关节炎1髋。根据Crowe分类，Ⅰ型79髋，Ⅱ型19髋，Ⅲ型6髋，Ⅳ型1髋。所有患者均使用高交联聚乙烯髋臼内衬联合26mm氧化锆股骨头。术后拍摄X线片分析髋臼假体周围的放射透过度及骨溶解情况。末次随访时测量垂直距离（骨盆下缘泪滴线与髋关节旋转中心垂线之间的距离）、水平距离（髋关节旋转中心与泪滴间线及泪滴下缘垂线之间的水平距离）以及髋臼杯前倾角。通过CT扫描及三维多平面重建（3D-MPR）分析髋臼和股骨的骨溶解情况。结合X线片及CT结果，根据Narkbunnam评分评估骨溶解情况。
发生下肢深静脉血栓2例。所有患者随访15至18年，平均15.9年。术后发生髋关节脱位1例、假体周围骨折1例，未发生髋臼松动或假体衬垫破裂。除1例患者术后髋臼出现透亮线外，其余83例患者髋臼或股骨均未出现任何透亮线。所有患者均未行髋关节翻修术。末次随访时X线片显示髋臼杯前倾角为-10°至39°，平均22°；垂直距离为3.5至47.1mm，平均24.6mm；水平距离为22.6至48.1mm，平均31.7mm。末次随访时所有患者的X线片及CT 3D-MPR图像均未显示髋臼或股骨骨溶解，各区域Narkbunnam评分为0分。
高交联聚乙烯假体不会增加THA术后骨溶解等长期并发症的风险。
