氧化锆、钢或钴铬股骨头骨水泥固定全髋关节置换术后聚乙烯磨损和杯迁移：一项使用放射立体测量术的随机试验 10 年二次分析。

Polyethylene wear and cup migration of cemented total hip arthroplasty with femoral heads made of oxidized zirconium, steel, or cobalt chromium: a 10-year secondary analysis from a randomized trial using radiostereometry.

机构信息

Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.

Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Coastal Hospital in Hagavik, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.

出版信息

Acta Orthop. 2024 Sep 30;95:578-585. doi: 10.2340/17453674.2024.41945.

DOI:10.2340/17453674.2024.41945

PMID:39347798

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11441331/

Abstract

BACKGROUND AND PURPOSE

We aimed to evaluate polyethylene (PE) wear, cup migration, and clinical outcome over 10 years in total hip arthroplasties (THA) using different articulations.

METHODS

This is a secondary analysis of 150 patients randomized into 5 groups, using different articulations: Charnley/Charnley Ogee for steel and conventional polyethylene (CPE), or Spectron EF/Reflection with either CPE or highly cross linked polyethylene (XLPE) cups, paired with heads made of either cobalt-chromium (CoCr) or oxidized zirconium (OxZr). All cups were cemented. Patients underwent repeated radiostereometric analysis (RSA) measurements for up to 10 years to assess wear and migration. Clinical outcome was assessed using Harris Hip Score (HHS).

RESULTS

After 10 years, the XLPE cups demonstrated low wear rates: 0.08 mm (95% confidence interval [CI] -0.11 to 0.26 mm) with CoCr heads and 0.06 mm (CI -0.14 to 0.26 mm) with OxZr heads, with a mean difference of 0.01 mm (CI -0.26 to 0.29 mm). In contrast, CPE cups exhibited significantly more wear: 1.35 mm (CI 1.16 to 1.55 mm) with CoCr heads and 1.68 mm (CI 1.44 to 1.92 mm) with OxZr heads, with a mean difference of 0.33 mm (CI 0.02 to 0.64 mm). The Charnley/Ogee group (CPE) showed PE wear of 0.34 mm (CI 0.12 to 0.56 mm). The CPE groups with OxZr and CoCr heads had 0.67 mm (CI 0.38 to 0.96 mm) and 0.35 mm (CI 0.09 to 0.61 mm) greater proximal migration respectively than the corresponding XLPE groups. HHS was similar across all groups.

CONCLUSION

We found no significant advantage of OxZr over CoCr heads in reducing wear or migration. XLPE demonstrated a major reduction in wear as well as a reduction in cup migration compared with CPE. Charnley performed better than the other CPE cups in terms of PE wear and cup migration. No differences in clinical outcome were found.

摘要

背景与目的

我们旨在评估使用不同关节的全髋关节置换术后聚乙烯（PE）磨损、杯迁移和临床结果超过 10 年。

方法

这是对 150 名随机分为 5 组的患者进行的二次分析，使用不同的关节：Charnley/Charnley Ogee 用于钢和传统聚乙烯（CPE），或 Spectron EF/Reflection 用于 CPE 或高度交联聚乙烯（XLPE）杯，与钴铬（CoCr）或氧化锆（OxZr）制成的头配对。所有杯子均用水泥固定。患者接受重复放射立体测量分析（RSA）测量长达 10 年，以评估磨损和迁移。使用 Harris 髋关节评分（HHS）评估临床结果。

结果

10 年后，XLPE 杯表现出低磨损率：CoCr 头为 0.08 毫米（95%置信区间[CI] -0.11 至 0.26 毫米），OxZr 头为 0.06 毫米（CI -0.14 至 0.26 毫米），平均差异为 0.01 毫米（CI -0.26 至 0.29 毫米）。相比之下，CPE 杯表现出明显更多的磨损：CoCr 头为 1.35 毫米（CI 1.16 至 1.55 毫米），OxZr 头为 1.68 毫米（CI 1.44 至 1.92 毫米），平均差异为 0.33 毫米（CI 0.02 至 0.64 毫米）。Charnley/Ogee 组（CPE）的 PE 磨损为 0.34 毫米（CI 0.12 至 0.56 毫米）。OxZr 和 CoCr 头的 CPE 组的近端迁移量分别比相应的 XLPE 组大 0.67 毫米（CI 0.38 至 0.96 毫米）和 0.35 毫米（CI 0.09 至 0.61 毫米）。HHS 在所有组之间相似。