Smith S E, Estok D M, Harris W H
Orthopaedic Biomechanics Laboratory, Massachusetts General Hospital, Boston 02114, USA.
J Arthroplasty. 1998 Jan;13(1):50-60. doi: 10.1016/s0883-5403(98)90075-4.
Seventy-two hips (67 patients) were reconstructed with the Acetabular Reconstruction Component (ARC, Howmedica, Rutherford, NJ), a chrome-cobalt component with sintered ingrowth beads and peripheral flanges for screw fixation. All the materials used in the ARC (metal, porous layer, and polyethylene) are identical to those used in the Porous Coated Anatomic (PCA) acetabular component (Howmedica), but the design is different. To determine the importance of design features alone, clinical results obtained with the 2 different designs made of identical materials were compared. The average follow-up period for patients with the ARC was 12 years (range, 10-13.3 years). Seven patients (7 hips) with the ARC died prior to the minimum 10-year follow-up period, none having undergone revision procedures. Overall, 3 acetabular components (4%) in 3 patients were revised, at an average of 8.5 years (range, 7.6-9.3 years) from the index operation. The reasons for revision were aseptic loosening, third-body polyethylene wear observed during a revision for femoral lysis, and acetabular component malposition and recurrent dislocation. The total incidence of acetabular aseptic loosening was 4% (3 of 72 hips). Pelvic osteolysis occurred in 3 cases (4%). In contrast, the incidence of acetabular revision of the PCA acetabular component at follow-up periods of 2-10 years is reported to be as high as 11% (range, 3-11%). Rates of aseptic loosening are as high as 30% (range, 3-30%) at substantially shorter follow-up periods, and the incidence of pelvic osteolysis associated with the PCA component is also as high as 30% (range, 5-30%). These differences may reflect differences in design between the 2 acetabular components, as the materials used were identical. In this, the longest reported average follow-up study of a successful cementless acetabular component, the aseptic loosening rate of 4% contrasts with the 42% rate at similar follow-up duration for cemented acetabular components placed by the same surgeon in patients of similar age.
使用髋臼重建组件（ARC，豪美蒂卡公司，新泽西州卢瑟福）对72个髋关节（67例患者）进行了重建，该组件是一种铬钴合金组件，带有烧结生长珠和用于螺钉固定的周边凸缘。ARC中使用的所有材料（金属、多孔层和聚乙烯）与多孔涂层解剖型（PCA）髋臼组件（豪美蒂卡公司）中使用的材料相同，但设计不同。为了单独确定设计特征的重要性，对由相同材料制成的两种不同设计的临床结果进行了比较。使用ARC的患者的平均随访期为12年（范围为10 - 13.3年）。7例使用ARC的患者（7个髋关节）在最短10年随访期之前死亡，均未接受翻修手术。总体而言，3例患者中的3个髋臼组件（4%）进行了翻修，距初次手术的平均时间为8.5年（范围为7.6 - 9.3年）。翻修原因包括无菌性松动、在股骨溶解翻修过程中观察到的第三体聚乙烯磨损、髋臼组件位置不当和复发性脱位。髋臼无菌性松动的总发生率为4%（72个髋关节中的3个）。骨盆骨溶解发生在3例（4%）。相比之下，据报道，PCA髋臼组件在2 - 10年随访期的髋臼翻修发生率高达11%（范围为3 - 11%）。在实质上更短的随访期内，无菌性松动率高达30%（范围为3 - 30%），与PCA组件相关的骨盆骨溶解发生率也高达30%（范围为5 - 30%）。这些差异可能反映了这两种髋臼组件在设计上的差异，因为使用的材料是相同的。在这项关于成功的非骨水泥髋臼组件的报道中最长的平均随访研究中，4%的无菌性松动率与同一位外科医生在年龄相似的患者中放置的骨水泥髋臼组件在相似随访期的42%的松动率形成对比。
