Sochart D H, Hardinge K
Department of Orthopaedic Surgery, Manchester Royal Infirmary, UK.
J Bone Joint Surg Br. 1998 Jul;80(4):577-84. doi: 10.1302/0301-620x.80b4.8284.
Between 1981 and 1986 two groups of patients received either Charnley low-friction arthroplasties or the Wrightington Frusto-Conical hip replacement with otherwise identical management before and after operation. There were 260 consecutive replacements in 215 patients in the first group and 260 consecutive procedures in 211 patients in the second. Both components of each design were cemented and featured a 22.25 mm femoral head, but the geometry of the stems differed. Of the patients lost to follow-up, 16 (18 hips) were in the Wrightington series and 24 (36 hips) in the Charnley series, and of those who have died 20 (23 hips) were Wrightington and 14 (16 hips) were Charnley. All surviving patients have been followed up clinically and radiologically or until revision was necessary. The mean length of follow-up for original surviving components in both series was 140 months (120 to 180). Pain, function and movement were measured by the grading system of Merle D'Aubigné and Postel and showed a marked improvement in both groups. There was little or no pain in 98% of patients in the Wrightington series and 96% in the Charnley series, while 93% and 85%, respectively, were entirely painfree. Trochanteric osteotomy was used in 292 cases overall, with a complication rate of 13% due to wire breakage, trochanteric bursitis or trochanteric detachment, requiring a further operation in 5.8% (17 hips). Heterotopic ossification was seen in 40% of cases in which trochanteric osteotomy had been performed (117 hips) but only 3% (10 hips) had clinically significant changes. After the direct lateral approach heterotopic ossification was seen in 24% (42 hips) with only 2% in class 3 or 4 (4 hips). Femoral osteolysis was more common in the Charnley series, occurring in 7.6% of cases (17 hips) as opposed to 2.1% (5 hips) in the Wrightington series. Ten acetabular and seven femoral components have been revised in the Wrightington series and 16 acetabular and 11 femoral implants in the Charnley series. Survivorship based on revision for aseptic loosening using the Kaplan-Meier technique showed survival of the femoral implant at 5, 10 and 15 years of 100%, 99% and 98%, respectively in the Wrightington and 100%, 99% and 87% in the Charnley series. The survival of the acetabular component at 10, 12 and 15 years respectively, was 100%, 99% and 95% for the Wrightington, and 99%, 98% and 84% for the Charnley. The survival of both the acetabular and femoral components of the Wrightington system at a mean of 11.7 years was better than that of the Charnley system, with a lower incidence of radiological loosening of unrevised components.
1981年至1986年间，两组患者分别接受了Charnley低摩擦人工关节置换术或Wrightington截锥-圆锥型髋关节置换术，手术前后的管理方式相同。第一组215例患者连续进行了260例置换手术，第二组211例患者连续进行了260例手术。每种设计的两个组件均采用骨水泥固定，股骨头直径为22.25 mm，但柄的几何形状不同。失访的患者中，Wrightington组有16例（18髋），Charnley组有24例（36髋）；死亡的患者中，Wrightington组有20例（23髋），Charnley组有14例（16髋）。所有存活患者均接受了临床和放射学随访，或直至需要翻修手术。两个系列中原始存活组件的平均随访时间为140个月（120至180个月）。采用Merle D'Aubigné和Postel分级系统对疼痛、功能和活动度进行评估，结果显示两组均有显著改善。Wrightington组98%的患者几乎没有或没有疼痛，Charnley组为96%；分别有93%和85%的患者完全无疼痛。总共292例患者采用了转子截骨术，因钢丝断裂、转子滑囊炎或转子分离导致的并发症发生率为13%，其中5.8%（17髋）需要再次手术。在进行转子截骨术的病例中，40%（117髋）出现了异位骨化，但只有3%（10髋）有临床意义的改变。采用直接外侧入路后，24%（42髋）出现了异位骨化，3级或4级的仅占2%（4髋）。股骨骨溶解在Charnley组更为常见，发生率为7.6%（17髋），而Wrightington组为2.1%（5髋）。Wrightington组有10个髋臼组件和7个股骨组件进行了翻修，Charnley组有16个髋臼组件和11个股骨植入物进行了翻修。采用Kaplan-Meier技术基于无菌性松动翻修的生存率显示，Wrightington组股骨植入物在5年、10年和15年的生存率分别为100%、99%和98%，Charnley组分别为100%、99%和87%。Wrightington组髋臼组件在10年、12年和15年的生存率分别为100%、99%和95%，Charnley组分别为99%、98%和84%。Wrightington系统髋臼和股骨组件在平均11.7年时的生存率优于Charnley系统，未翻修组件的放射学松动发生率更低。
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