Schmalzried T P, Fowble V A, Ure K J, Amstutz H C
Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA, USA.
Clin Orthop Relat Res. 1996 Aug(329 Suppl):S106-14. doi: 10.1097/00003086-199608001-00011.
High volumetric wear of polyethylene plays a central role in periprosthetic bone resorption and the failure of metal on polyethylene total hip resurfacing prostheses. An assessment of technique, initial fixation, and the early results of 21 hips in 19 patients implanted with a metal on metal bearing total hip resurfacing prosthesis, 4 all cementless Wagner prostheses and 17 all cemented McMinn prostheses, is presented. Pain relief was equal to conventional total hip replacement with a better functional result with an average followup of 16 months (range, 10-25 months). The femoral component position and fixation is satisfactory in all 21 hips and there were no femoral neck notches or fractures. All 4 cementless Wagner acetabular components appear to be osseointegrated with stable interfaces. The cemented McMinn acetabular components, however, have shown progressive cement bone interface radiolucencies in 12 hips. This preliminary experience underscores the importance of obtaining secure initial fixation. There have been no problems directly attributable to the metal on metal bearing but the authors will continue to follow these hips and evaluate their performance. The metal on metal hip surface replacement procedure is in evolution. This ongoing experience will help guide total hip surface replacement component design and implantation techniques.
聚乙烯的高容积磨损在假体周围骨吸收以及金属对聚乙烯全髋关节表面置换假体的失败中起着核心作用。本文介绍了对19例患者的21个髋关节的技术、初始固定情况及早期结果的评估，这些髋关节分别植入了金属对金属承重全髋关节表面置换假体、4个非骨水泥型Wagner假体和17个骨水泥型McMinn假体。平均随访16个月（范围10 - 25个月），疼痛缓解情况与传统全髋关节置换相当，功能结果更好。21个髋关节的股骨部件位置和固定情况均令人满意，未出现股骨颈切迹或骨折。所有4个非骨水泥型Wagner髋臼部件似乎都实现了骨整合，界面稳定。然而，17个骨水泥型McMinn髋臼部件中有12个出现了骨水泥 - 骨界面的渐进性透光影。这一初步经验强调了获得牢固初始固定的重要性。未出现直接归因于金属对金属承重的问题，但作者将继续随访这些髋关节并评估其性能。金属对金属髋关节表面置换手术仍在不断发展。这一持续的经验将有助于指导全髋关节表面置换部件的设计和植入技术。
