Longobardi Vincenzo, Minelli Marco, Pietrogrande Giacomo, Anzillotti Giuseppe, Della Rocca Federico, Loppini Mattia
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
J Clin Med. 2025 Sep 19;14(18):6621. doi: 10.3390/jcm14186621.
Long-term survivorship in total hip arthroplasty (THA) is influenced by implant stability and stress distribution to surrounding bone. Isoelastic acetabular components are monoblock polyethylene cups with a low elastic modulus, which were developed to reduce stress shielding and enhance periacetabular bone preservation. This systematic review aimed to evaluate the mid- to long-term clinical outcomes, wear rate, and survivorship of isoelastic cups in primary THA with a minimum follow-up of five years. A systematic literature search was performed in April 2025 across PubMed, Embase, Cochrane Library, and Google Scholar following PRISMA 2020 guidelines. Inclusion criteria comprised clinical studies on isoelastic acetabular cups in primary THA with a minimum of five years of follow-up. Data on survivorship, complications, clinical outcomes, wear, and radiological performance were extracted and analyzed. Risk of bias in each study was assessed through the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. Twelve studies, encompassing 1491 hips, met the inclusion criteria. Mean follow-up was 8.1 years. Overall implant survival rate ranged from 82.7% to 100%. Mean Harris Hip Score was 92.6, with low reported pain and high satisfaction. Mean annual wear was 0.05 mm/year. Vitamin E-infused highly cross-linked polyethylene (VEHXLPE) cups demonstrated lower femoral head penetration compared to UHMWPE. A randomized trial showed reduced bone loss in the polar region with isoelastic cups versus modular titanium cups (4.9% versus 15.9%, = 0.005). Complication and revision rates were low, though heterogeneity in cup positioning reporting and variable follow-up durations were noted. Isoelastic acetabular components demonstrate excellent survivorship, low wear rates, and favorable clinical outcomes at mid- to long-term follow-up. High-quality, long-term comparative studies are needed to confirm these findings across broader patient populations.
全髋关节置换术（THA）的长期生存率受植入物稳定性及周围骨应力分布的影响。等弹性髋臼组件是具有低弹性模量的整体式聚乙烯杯，其设计目的是减少应力遮挡并增强髋臼周围骨的保留。本系统评价旨在评估初次THA中使用等弹性杯且至少随访五年的中长期临床结局、磨损率和生存率。2025年4月，按照PRISMA 2020指南，在PubMed、Embase、Cochrane图书馆和谷歌学术上进行了系统的文献检索。纳入标准包括初次THA中使用等弹性髋臼杯且至少随访五年的临床研究。提取并分析了关于生存率、并发症、临床结局、磨损和放射学表现的数据。通过观察性研究的纽卡斯尔-渥太华量表（NOS）和随机对照试验的Cochrane偏倚风险2（RoB 2）工具评估每项研究的偏倚风险。12项研究（共1491髋）符合纳入标准。平均随访时间为8.1年。总体植入物生存率在82.7%至100%之间。平均Harris髋关节评分92.6，疼痛报告率低且满意度高。平均年磨损为0.05毫米/年。与超高分子量聚乙烯（UHMWPE）相比，含维生素E的高交联聚乙烯（VEHXLPE）杯显示出较低的股骨头穿透率。一项随机试验表明，与模块化钛杯相比，使用等弹性杯时极区骨丢失减少（4.9%对15.9%，P = 0.005）。尽管注意到杯位置报告存在异质性且随访时间各不相同，但并发症和翻修率较低。等弹性髋臼组件在中长期随访中显示出优异的生存率、低磨损率和良好的临床结局。需要高质量的长期比较研究，以在更广泛的患者群体中证实这些发现。
