Adil Syed A, Gutbrod Joseph T, Shah Vivek P, Pashos Gail E, Bendich Ilya, Clohisy John C
Department of Orthopaedic Surgery, Washington University School of Medicine, Washington University in St Louis, St. Louis, Missouri.
J Arthroplasty. 2025 Sep 8. doi: 10.1016/j.arth.2025.08.077.
Total hip arthroplasty (THA) with third-generation alumina ceramic heads on highly cross-linked polyethylene liners (HXLPE) has demonstrated excellent outcomes in young patients. However, there is limited data for fourth-generation ceramic heads. The purpose of our study was to report on clinical and wear, outcomes of THA with fourth-generation 32-mm ceramic femoral heads and HXLPE liners in patients 50 years or younger at 10-year minimum follow-up.
This was a retrospective study of 103 THAs with fourth-generation 32-mm ceramic femoral heads on HXLPE between December 2008 and December 2010. The mean age was 37 years (range, 13 to 50). The modified Harris Hip Score, University of California, Los Angeles Activity Score, and Western Ontario and McMaster University Osteoarthritis Index pain score were collected preoperatively and at each follow-up. Martell Hip Analysis was used for wear calculations.
Survivorship from all-cause revision was 97.1% (95% confidence interval (CI), 93.8 to 100.0) at 5 years, 97.1% (95% CI, 93.8 to 100.0) at 10 years, and 95.4% (95% CI, 90.9 to 99.9) at 15 years. Survivorship from wear-related revision was 100% at 15 years. There were four hips (3.9%) that underwent revision at a mean of 5.1 years (range, 0.04 to 13.2) postoperatively. The mean linear wear rate was 0.0184 mm/year (SD ± 0.043); the mean volumetric wear rate was 18.38 mm/year (SD ± 22.55). Improvements were observed in the modified Harris Hip Score (48 ± 16 to 84 ± 22; P < 0.001), University of California, Los Angeles score (5.5 ± 2.3 to 6.2 ± 2.1; P = 0.031), and Western Ontario and McMaster Universities Arthritis Index pain score (45 ± 21 to 86 ± 23; P < 0.001). Patient satisfaction scores were 73% "extremely satisfied" and 13% "very satisfied."
The fourth-generation ceramic 32-mm femoral heads on HXLPE in THA for patients aged 50 years or younger demonstrate excellent survivorship, minimal wear, and high patient satisfaction at a 10-year minimum follow-up.
在年轻患者中，采用第三代氧化铝陶瓷股骨头与高交联聚乙烯内衬（HXLPE）进行全髋关节置换术（THA）已取得了出色的效果。然而，关于第四代陶瓷股骨头的数据有限。我们研究的目的是报告在至少10年的随访中，50岁及以下患者采用第四代32毫米陶瓷股骨头和HXLPE内衬进行THA的临床及磨损结果。
这是一项对2008年12月至2010年12月期间103例采用第四代32毫米陶瓷股骨头和HXLPE的THA病例的回顾性研究。平均年龄为37岁（范围13至50岁）。术前及每次随访时收集改良Harris髋关节评分、加利福尼亚大学洛杉矶分校活动评分以及西安大略和麦克马斯特大学骨关节炎指数疼痛评分。采用Martell髋关节分析进行磨损计算。
5年时全因翻修的生存率为97.1%（95%置信区间[CI]，93.8至100.0），10年时为97.1%（95%CI，93.8至100.0），15年时为95.4%（95%CI，90.9至99.9）。15年时因磨损相关翻修的生存率为100%。术后平均5.1年（范围0.04至13.2年）有4例髋关节（3.9%）进行了翻修。平均线性磨损率为0.0184毫米/年（标准差±0.043）；平均体积磨损率为18.38立方毫米/年（标准差±22.55）。改良Harris髋关节评分（48±16至84±22；P<0.001）、加利福尼亚大学洛杉矶分校评分（5.5±2.3至6.2±2.1；P = 0.031）以及西安大略和麦克马斯特大学关节炎指数疼痛评分（45±21至86±23；P<0.001）均有改善。患者满意度评分中，73%“极其满意”，13%“非常满意”。
在至少10年的随访中，50岁及以下患者THA采用第四代32毫米陶瓷股骨头和HXLPE内衬表现出出色的生存率、最小的磨损以及较高的患者满意度。
