Cordero-Ampuero José, Velasco Paula, Payo-Rodríguez Jorge, Peñalver-Andrada Pablo, González-Fernández Enrique
Department of Orthopaedic Surgery, University Hospital La Princesa, c/ Diego de León 62, 28006, Madrid, Spain.
Medicine School, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo s/n, Madrid, Spain.
J Clin Orthop Trauma. 2024 Sep 30;57:102555. doi: 10.1016/j.jcot.2024.102555. eCollection 2024 Oct.
Few studies compare complications and results in ceramic-ceramic (CeCe) metal-on-crosslink polyethylene (Me-XLPE) hip prosthesis.
of 2 series of hydroxyapatite-coated Furlong Active implanted with identical protocol by 1 surgeon in 1 hospital from 2006 to 2014.
CeCe (Biolox Forte/Delta) in 35 cases of 53.7 ± 10.6 years (25-69) (21 males, 60 %), Me-XLPE in 65 of 69.0 ± 8.9 years (42-81) (36 males, 55 %); age was different (p < 0.00001), but not sex (p = 0.6565). Head diameter: 28 mm in 19, 32 mm in 9 and 36 mm in 7 CeCe hips; 28 mm in 63, 32 mm in 1 and 36 mm in 1 Me-XLPe hips.
FOLLOW-UP: 10.5 ± 3.1 years (1-15) in ceramic, 9.8 ± 3.8 years (2-15) in Me-XLPE.
Survivorship without additional surgery or closed reduction at 15 years: 91.0 % in ceramic, 83.8 % in Me-XLPE joints. Survivorship without component exchange at 15 years: 93.9 % in ceramic, 93.6 % in Me-XLPE joints.
CeCe joints suffered 2 infections, 1 isolated dislocation, and 1 Vancouver-C fracture. Me-XLPE joints presented 2 infections (p = 0.6101), 5 isolated (p = 0.6621) and 2 recurrent dislocations (p = 0.5454), and 4 Vancouver-B fractures (p = 0.6548).At final follow-up, Harris Hip Score averaged 93.2 ± 13.7 (23-100) in ceramic and 94.3 ± 8.7 (65-100) in XLPE joints (p = 0.64552).Measured radiographic wear reached 0.06 ± 0.38 mm (0-1.5) (0.0057 mm/year) in CeCe and 0.16 ± 0.5 mm (0-2) (0.0163 mm/year) in Me-XLPE (p = 0.30302). At final radiographic follow-up, osteolysis was present in 8 Charnley-De Lee zones (6 patients) (17 %) of ceramic cups and in 25 zones (15 patients) (23 %) of XLPE cups (p = 0.980127).
At 10 years follow-up, metal-XLPE and ceramic-ceramic joints in Furlong-H-A.C. Active present no significant differences in complications, clinical score, wear, acetabular osteolysis, or survivorship without component exchange.Nevertheless, survivorship without any surgery or closed reduction is different because of the high rate of dislocation in 28 mm metal-poly joints.
很少有研究比较陶瓷对陶瓷（CeCe）与金属对交联聚乙烯（Me-XLPE）髋关节假体的并发症及效果。
2006年至2014年，在一家医院由1名外科医生按照相同方案植入了2组羟基磷灰石涂层的弗隆主动型假体。
35例CeCe（Biolox Forte/Delta）假体，患者年龄53.7±10.6岁（25 - 69岁）（男性21例，占60%）；65例Me-XLPE假体，患者年龄69.0±8.9岁（42 - 81岁）（男性36例，占55%）；年龄存在差异（p < 0.00001），但性别无差异（p = 0.6565）。CeCe髋关节假体的股骨头直径：19例为28mm，9例为32mm，7例为36mm；Me-XLPe髋关节假体的股骨头直径：63例为28mm，1例为32mm，1例为36mm。
陶瓷假体组随访时间为10.5±3.1年（1 - 15年），Me-XLPE假体组随访时间为9.8±3.8年（2 - 15年）。
15年时无需再次手术或闭合复位的假体生存率：陶瓷假体组为91.0%，Me-XLPE关节组为83.8%。15年时无需更换假体部件的生存率：陶瓷假体组为93.9%，Me-XLPE关节组为93.6%。
CeCe关节组发生2例感染、1例单纯性脱位和1例温哥华C型骨折。Me-XLPE关节组发生2例感染（p = 0.6101）、5例单纯性脱位（p = 0.6621）和2例复发性脱位（p = 0.5454），以及4例温哥华B型骨折（p = 0.6548）。在最后一次随访时，陶瓷假体组Harris髋关节评分平均为93.2±13.7（23 - 100），Me-XLPE关节组为94.3±8.7（65 - 100）（p = 0.64552）。测量得到的影像学磨损在CeCe假体中为0.06±0.38mm（0 - 1.5）（每年0.0057mm），在Me-XLPE假体中为0.16±0.5mm（0 - 2）（每年0.0163mm）（p = 0.30302）。在最后一次影像学随访时，陶瓷髋臼杯的Charnley - De Lee区有8个区域（6例患者）（17%）出现骨溶解，Me-XLPE髋臼杯有25个区域（15例患者）（23%）出现骨溶解（p = 0.980127）。
在10年随访中，弗隆-H-A.C.主动型假体的金属-XLPE和陶瓷对陶瓷关节在并发症、临床评分、磨损、髋臼骨溶解或无需更换假体部件的生存率方面无显著差异。然而，由于28mm金属-聚乙烯关节脱位率高，无需任何手术或闭合复位的生存率有所不同。
