Lau Lawrence C M, Wong Kin Y, Hu Hongjian, Cheung Man H, Ng Fu Y, Fu Henry, Chan Ping K, Chiu Kwong Y
Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong, China.
Bone Jt Open. 2025 May 1;6(5 Supple A):14-21. doi: 10.1302/2633-1462.65.BJO-2024-0197.R1.
This study aimed to evaluate the survival of a cementless component without screw holes in total hip arthroplasty (THA) at a minimum follow-up of 20 years. This design has the benefits of maximizing bone contact and reducing osteolysis by eliminating channels to backside wear. However, transacetabular screws cannot be used.
A total of 71 hips in 58 patients receiving the same model of cementless component without screw holes (Depuy Duraloc 100 hydroxyapatite (HA) component) from June 1999 to March 2003 were prospectively followed up. All patients were allowed to have immediate full weightbearing. The mean age at THA was 53.7 years (28 to 74). Osteonecrosis was the leading cause of THA. Survival was assessed with any revision and component revision as the endpoint. Radiological parameters, including lateral opening angle, and the components' vertical and horizontal migration distances, were measured and compared between the early postoperative period and final follow-up.
Overall, 54 hips were assessed at a minimum 20-year follow-up. The mean follow-up was 22.9 years (20.9 to 24.5). Two component revisions occurred at 17.5 and 17.6 years later. Both components were well fixed but were revised, due to the need to upsize the articulation and component malpositioning, respectively. Conventional polyethylene (PE) was used in both hips, and 14 other hips were revised with the components well fixed and not revised. The estimated survival of the acetabular component and THA at 20 years was 96.4% and 74.5%, respectively. Mean changes in lateral opening angle and vertical and horizontal migration distances were 0.48° (SD 1.45°), -0.06 mm (SD 1.44), and -0.36 mm (SD 1.36), respectively, with no statistical significance.
This study provides evidence of excellent long-term survival of cementless components without screw holes. Immediate postoperative weightbearing did not lead to component migration in the long term.
本研究旨在评估全髋关节置换术（THA）中无螺钉孔的非骨水泥型假体在至少20年随访期内的生存率。这种设计具有使骨接触最大化以及通过消除向后方磨损的通道来减少骨溶解的优点。然而，不能使用经髋臼螺钉。
对1999年6月至2003年3月期间接受同一型号无螺钉孔非骨水泥型假体（Depuy Duraloc 100羟基磷灰石（HA）假体）的58例患者的71髋进行前瞻性随访。所有患者均被允许立即完全负重。THA时的平均年龄为53.7岁（28至74岁）。股骨头坏死是THA的主要原因。以任何翻修和假体翻修为终点评估生存率。测量并比较术后早期和最终随访时的放射学参数，包括外侧开口角度以及假体的垂直和水平移位距离。
总体而言，54髋接受了至少20年的随访。平均随访时间为22.9年（20.9至24.5年）。在17.5年和17.6年后发生了2例假体翻修。两个假体均固定良好，但分别由于需要增大关节尺寸和假体位置不当而进行了翻修。两髋均使用了传统聚乙烯（PE），另外14髋在假体固定良好且未进行翻修的情况下进行了翻修。髋臼假体和THA在20年时的估计生存率分别为96.4%和74.5%。外侧开口角度以及垂直和水平移位距离的平均变化分别为0.48°（标准差1.45°）、-0.06 mm（标准差1.44）和-0.36 mm（标准差1.36），均无统计学意义。
本研究提供了无螺钉孔非骨水泥型假体长期优异生存率的证据。术后立即负重在长期内并未导致假体移位。
