Davey Martin S, Farrell Conor, Kilkenny Conor, Medlar Conor, McGoldrick Niall P, Quinlan John F
Tallaght University Hospital, Dublin, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
Bone Jt Open. 2025 Apr 8;6(4):413-418. doi: 10.1302/2633-1462.64.BJO-2025-0003.R1.
Although the use of metal-on-metal (MoM) implants in total hip arthroplasty (THA) remains a topic of controversy, prior literature has reported satisfactory ten-year clinical and radiological outcomes following Birmingham Hip Resurfacing (BHR), subsequently resulting in a recent Orthopaedic Data Evaluation Panel (ODEP) rating of 15 A*. Therefore, the purpose of this study was to evaluate the functional outcomes, radiological outcomes, and revision rates following BHR at a minimum of 15 years' follow-up in a non-designer centre.
Two investigators performed a retrospective review to identify consecutive patients who underwent BHR in our institution over a seven-year period (2003 to 2009, at minimum 15 years' follow-up) in a non-designer centre. Evaluation of clinical (Oxford Hip Scores (OHS)), biochemical (cobalt and chromium levels), and radiological (plain film radiographs) outcomes was carried out. Survivorship analysis was performed using Kaplan-Meier curves, with all-cause surgical revision defined as a definitive endpoint for analysis. Descriptive statistical analysis was carried out.
Overall, 96 patients (86 males) at a mean age of 51.4 years (SD 9.9; 27 to 69) underwent 105 BHR procedures (nine bilateral) with at least 15 years' minimum follow-up. Mean OHS was 38.3 (SD 9.6; 17 to 48) at 15-year minimum follow-up. The overall survivorship was 94.3% at 15 years post BHR, with an all-cause revision rate of 5.7%. Only eight BHR prostheses (8.2%) had radiolucent lines on plain films, none of which were listed for revision at the time of latest follow-up, while 32 patients had undergone MRI at 170 months (SD 54.9; 6 to 249) post BHR, with evidence of fluid collection, aseptic lymphocyte-dominant vasculitis-associated lesion, and metallosis identified on the MRI of four patients, four patients, and one patient, respectively. For 98.4% (60/61) of patients, cobalt and chromium values were either within normal limits (68.9%, n = 42) or less than double the upper limit of normal (29.5%, n = 18).
This study found that BHR demonstrates an acceptable survivorship of 94% at 15 years of minimum follow-up, with satisfactory clinical and radiological outcomes to reflect this low all-cause revision rate in a non-designer centre.
尽管金属对金属（MoM）植入物在全髋关节置换术（THA）中的应用仍是一个有争议的话题，但先前的文献报道了伯明翰髋关节表面置换术（BHR）术后十年令人满意的临床和放射学结果，随后导致骨科数据评估小组（ODEP）最近将其评为15 A*。因此，本研究的目的是在一个非指定中心对接受BHR的患者进行至少15年的随访，以评估其功能结果、放射学结果和翻修率。
两名研究者进行了一项回顾性研究，以确定在我们机构七年期间（2003年至2009年，至少15年随访）在非指定中心连续接受BHR的患者。对临床（牛津髋关节评分（OHS））、生化（钴和铬水平）和放射学（普通X线片）结果进行了评估。使用Kaplan-Meier曲线进行生存分析，将所有原因的手术翻修定义为分析的最终终点。进行了描述性统计分析。
总体而言，96例患者（86例男性），平均年龄51.4岁（标准差9.9；27至69岁）接受了105例BHR手术（9例双侧），至少有15年的最短随访。在至少15年的随访时，平均OHS为38.3（标准差9.6；17至48）。BHR术后15年的总体生存率为94.3%，所有原因的翻修率为5.7%。只有8个BHR假体（8.2%）在普通X线片上有透光线，在最近一次随访时均未列入翻修名单，而32例患者在BHR术后170个月（标准差54.9；6至249）进行了MRI检查，分别在4例、4例和1例患者的MRI上发现有积液、无菌性淋巴细胞为主的血管炎相关病变和金属沉着症。对于98.4%（60/61）的患者，钴和铬值要么在正常范围内（68.9%，n = 42），要么低于正常上限的两倍（29.5%，n = 18）。
本研究发现，BHR在至少15年的随访中显示出94%的可接受生存率，临床和放射学结果令人满意，反映了非指定中心这种低所有原因翻修率的情况。
