金属对金属全髋关节置换术中孤立髋臼杯翻修术：低并发症策略仅在半数病例中可行。
Isolated acetabular cup revision in Metal-on-Metal total hip arthroplasty: a low-complication strategy feasible in only half of cases.
作者信息
Duda Cristobal, Bouché Pierre-Alban, Gauthier Morgan, Gonzalez Amanda, Zingg Matthieu, Hannouche Didier
机构信息
University Hospital of Geneva, Geneva, Switzerland.
University of Geneva, Geneva, Switzerland.
出版信息
Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06534-z.
PURPOSE
There is still a debate regarding the removal of the femoral stem due to the risk of trunnion. To answer this question, we conducted a study to compare long terms outcomes of isolated acetabular to total revision of MoM THA using an institutional arthroplasty registry.
METHODS
From 1996 to 2019, 150 patients (12.5%) of the 1202 revision THAs (rTHA) recorded in Geneva Arthroplasty Registry (GAR) underwent a revision of a MoM THA. After matching the two groups,126 patients were finally included: 63 in each group. The mean age was 64.4 (SD 11.6) years, 48.4% (61/126) were women with a mean BMI of 27.2 (SD 5.5) Kg/m2.
RESULTS
The overall survival rate was 88.1% [79.9-97.2%] at ten years. 10-year survival rate was 93.5% [86.2-100.0%] after isolated acetabular rTHA and 79.5% [61.7-100.0%] after total rTHA (p = 0.16). Regarding Hip Harris score and Merle d'Aubigne score, no difference at last follow-up was observed between the two groups (respectively: p = 0.39; p = 0.33). Regarding the chrome, cobalt, and nickel level reduction, no difference was observed between the two groups (respectively, p = 0.38, 0.81 and 0.97).
CONCLUSION
No difference was observed between isolated acetabular and total revision of MoM THAs regarding survival rate and ions levels at long term. It seems advisable to perform an isolated acetabular revision of a MoM THA when it is indicated.
LEVELS OF EVIDENCE
Level III, case control studies.
目的
由于柄部件存在风险，对于股骨柄的移除仍存在争议。为回答这个问题，我们开展了一项研究，利用机构关节置换登记系统比较金属对金属全髋关节置换术（MoM THA）单纯髋臼翻修与全翻修的长期结果。
方法
1996年至2019年期间，日内瓦关节置换登记系统（GAR）记录的1202例翻修全髋关节置换术（rTHA）中有150例患者（12.5%）接受了MoM THA翻修。在对两组进行匹配后，最终纳入126例患者：每组63例。平均年龄为64.4（标准差11.6）岁，48.4%（61/126）为女性，平均体重指数为27.2（标准差5.5）kg/m²。
结果
十年时总体生存率为88.1%[79.9 - 97.2%]。单纯髋臼rTHA后10年生存率为93.5%[86.2 - 100.0%]，全rTHA后为79.5%[61.7 - 100.0%]（p = 0.16）。关于髋关节Harris评分和Merle d'Aubigne评分，两组在最后一次随访时未观察到差异（分别为：p = 0.39；p = 0.33）。关于铬、钴和镍水平的降低，两组之间未观察到差异（分别为，p = 0.38、0.81和0.97）。
结论
在长期生存率和离子水平方面，MoM THA单纯髋臼翻修与全翻修之间未观察到差异。当有指征时，对MoM THA进行单纯髋臼翻修似乎是可取的。
证据等级
三级，病例对照研究。
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