陶瓷-陶瓷全髋关节置换术中大小直径股骨头的早期比较

[目的]分析陶瓷-陶瓷全髋关节置换术中分别应用不同直径的股骨头的临床效果,并作相应的比较.[方法]2008年9月～2009年10月,本院共施行136例(157髋)陶瓷-陶瓷全髋关节置换术,其中男59例(68髋),女77例(89髋),年龄27～81岁(平均61.3岁);均采用德国LINK BetaCupTm复合陶瓷界面非骨水泥压配固定髋臼系统进行全髋关节置换;术前诊断显示股骨头缺血性坏死76髋,发育性髋关节脱位46髋,骨关节炎15髋,强直性脊柱炎11髋,类风湿性关节炎3髋,股骨颈骨折GardenⅣ型6髋.术中根据髋臼磨挫直径大小选择相应的股骨头假体(直径分别为28,32,36 mm),根据股骨头假体的直径大小分为3组,Ф28 mm组69髋,(Ф32 mm组31髋,Ф36 mm组57髋,通过术前及术后的Harris评分了解髋关节功能及疼痛的改善情况.[结果]随访时间12～18个月(平均16.2个月),(Ф28 mm、Ф32 mm、Ф36 mm股骨头术前Harris总评分、疼痛评分、功能评分、活动范围评分比较无明显差异(P>0.05),术后Harris总评分、疼痛评分、功能评分比较无明显差异(P>0.05),每组术后Harris评分较术前明显改善(P<0.05),股骨头直径越大术后活动范围改善就越明显(P<0.05).[结论]陶瓷-陶瓷全髋关节置换术股骨头直径的选择对术后疼痛的缓解差异性并无影响,但在髋关节活动范围改善方面大直径的球头要优于小直径的球头.陶瓷-陶瓷全髋关节置换术对手术技术及患者自身条件的要求较高,不可盲目追求大直径而忽略髋臼的实际承载条件.     

陶瓷对陶瓷人工髋关节置换手术技巧及相关研究

[目的]介绍陶瓷对陶瓷髋关节置换的手术方法,分析2种陶瓷髋假体的特点。[方法]自2001年11月～2006年6月间行101例123髋初次全髋置换手术,分别使用Osteonics ABC(型和Option(陶瓷对陶瓷人工髋关节系统。术中严格控制假体位置,并遵循安放陶瓷假体的特殊技巧。取2款陶瓷髋假体进行体外实验:测量理论最大活动范围,测量不同的臼杯位置对发生撞击的影响。[结果]临床和影像学结果令人满意。无骨溶解,无陶瓷碎裂和感染等严重并发症。1例陶瓷部件术中发生边缘崩裂现象,2例出现一过性髂腰肌刺激症状。实验结果:髋臼假体位置直接影响关节活动度。超半径设计对髋关节活动范围影响明显,理论活动范围和臼杯安放位置允许区间均较小。[结论]人工全髋置换术使用陶瓷对陶瓷型假体,需要掌握特殊的手术技巧,超半径设计假体安放要求适当增加髋臼假体前倾角。     

第四代髋关节陶瓷内衬碎裂后翻修

目的探讨并总结第四代陶瓷内衬碎裂原因及翻修手术后疗效。方法选择2013年于山东省济宁市第一人民医院就诊的1例右侧髋臼陶瓷内衬破裂患者,对其进行翻修手术。结果术后2周拆线,切口愈合良好,右髋关节弹响及疼痛均消失,患者主动屈伸活动未见异常。术后12个月复查骨盆正位,假体位置正常,未见明显松动,关节内未见高密度金属影。结论陶瓷-陶瓷在全髋关节置换中是相对理想的界面,但术后异响及陶瓷碎裂问题仍有待解决,出现异响后应及时密切观察。明确陶瓷假体碎裂后应尽早行髋关节翻修手术。     

陶瓷对陶瓷界面全髋关节置换术后疗效与血清金属离子浓度分析

目的 分析陶瓷对陶瓷全髋关节置换术后临床疗效与血清金属离子浓度变化情况.方法 纳入自2016-01-2018-01采用陶瓷对陶瓷全髋关节置换术治疗的60例(60髋)股骨头缺血性坏死,术后1年进行髋关节Harris评分,并测定患者血清中铝离子及锆离子浓度.结果 60例均获得1年随访,术后1年髋关节功能Harris评分为(...     

陶瓷对陶瓷全髋关节置换术治疗成人髋关节发育不良的近期疗效

目的探索陶瓷对陶瓷全髋关节置换术治疗成人髋关节发育不良(DDH)的近期疗效。方法 20例(27髋)DDH行陶瓷对陶瓷全髋关节置换术,比较手术前后Harris评分、VAS评分,观察术后双下肢等长否、有无关节异响、假体位置。结果20例术后均无感染、假体碎裂发生,假体位置良好,未见明显松动现象,1例出现关节异响。术后所有患者双下肢等长。术后平均VAS评分由术前5.78分降至1.02分,术后平均Harris评分由术前50.25分上升为90.76分。结论陶瓷对陶瓷全髋关节置换术治疗成人髋关节发育不良能收到很好的近期疗效。     

陶瓷-陶瓷髋关节置换术髋臼假体放置角度对中期临床疗效的影响

目的探讨陶瓷-陶瓷髋关节置换术中髋臼假体放置角度对中期临床疗效的影响。方法将进行第四代陶瓷-陶瓷髋关节置换术的60例患者随机分为两组,其中试验组髋臼假体放置角度为30°~40°,对照组髋臼假体放置角度为40°~50°。所有患者术前行Harris髋关节评分,术后6、12个月及每隔1年进行随访,进行Harris髋关节评分、术后疼痛持续时间、术后拐杖使用时间、并发症发生率、基于X线片的内植物情况分析(假体碎裂、假体柄下沉、髋臼杯移位、假体周围骨质等)及髋关节功能状况等调查。结果所有患者术后5年Harris髋关节评分均较术前明显增高,试验组Harris髋关节评分较对照组明显增高(P<0.05)。试验组术后疼痛持续时间为(3.14±0.37)d,对照组为(3.13±0.35)d,两者无统计学差异(P>0.05);试验组术后拐杖使用时间为(14.83±1.63)d,对照组为(15.32±2.64)d,两者无统计学差异(P>0.05);试验组术后平均住院日为(4.93±0.38)d,对照组为(4.85±0.64)d,两者无统计学差异(P>0.05)。术后5年,两组患者异位骨化及股骨假体松动发生率无统计学差异(P>0.05),试验组患者假体碎裂、髋臼杯松动发生率较对照组明显降低(P<0.05)。结论陶瓷-陶瓷髋关节置换术中适当降低髋臼杯外展角对于假体远期生存率具有较好的意义。     

陶瓷对陶瓷全髋关节置换术的初步体会

目的回顾分析本组陶瓷对陶瓷全髋关节置换术的临床结果,探讨行全陶人工髋关节置换的手术体会。方法本组在2000年3月~2008年4月间,对行陶瓷对陶瓷全髋关节置换术的患者进行随访,随访时间超过24个月的有202例(269髋),其中男123例(178髋),女79例(91髋),平均年龄46岁,随访时间平均41(24~122)个月。所有这些患者均进行了临床和影像学评估。结果本组患者术前Harris评分平均53.47(3~85)分,术后平均为90.66(59~100)分。术后随访无患者有关节异响的主诉,未见假体松动,未发生假体周围感染,无翻修患者。无可观察到的磨损和骨溶解,无明显异位骨化。本组患者术中出现1例边缘崩裂。四种不同公司的髋臼对患术后Harris评分无显著影响。结论本研究的短期随访结果显示,现代陶瓷对陶瓷全髋关节置换术对于年轻的骨质量较好的患者是一种良好的选择,但需更长期的随访以验证其长期疗效。     

陶瓷-陶瓷全髋关节置换术治疗年龄<40岁患者的疗效观察

目的探讨陶瓷-陶瓷全髋关节置换术(THA)治疗年龄40岁髋关节疾病患者的疗效。方法回顾性分析52例年龄40岁因髋关节疾病采用陶瓷-陶瓷THA治疗患者的临床资料。临床疗效评估重点观察手术前后Harris评分;影像学评估重点观察术后脱位率、骨溶解及陶瓷碎裂发生率等。结果 52例均获得随访,时间8~16(12.1±3.7)年。Harris评分由术前9~68(49.3±9.7)分提高到末次随访时68~98(95.1±6.7)分(P0.05)。除1例(1.9%)在术后7 d出现髋关节后脱位外,其余患者均无脱位。2例(3.8%)随访中出现关节异响,1例(1.9%)术后8年出现陶瓷碎裂。至末次随访,未出现假体松动及假体周围骨溶解。结论采用陶瓷-陶瓷THA治疗年龄40岁髋关节疾病患者可以获得满意的临床疗效。     

陶瓷-陶瓷全髋关节置换术中期随访结果的报道

目的分析陶瓷-陶瓷全髋关节置换术（THA）平均5年随访的临床结果。方法延长随访先前报道2001年9月至2007年12月本组进行的1139例（1208髋）陶瓷-陶瓷THA,包括Stryker陶瓷-陶瓷全髋关节354例（368髋）,普鲁士陶瓷-陶瓷全髋关节672例（727髋）,Lima陶瓷-陶瓷全髋关节（三明治型）113例（113髋）。其中,男617例,女522例,平均年龄59.5岁（39~75岁）。术前诊断包括股骨头缺血性坏死334例,发育性髋关节发育不全238例,骨性关节炎335例,强直性脊柱炎84例,类风湿性关节炎87例,股骨颈骨折GardenⅣ型61例。至2011年3月,共有1017例病例获得随访。结果以翻修为终点的假体生存率为98.5%,并发症包括脱位11例,其中3例因为反复脱位而翻修;假体周围骨折5例,其中3例因假体松动而进行翻修;感染7例,均行二期翻修;陶瓷碎裂3例,2例进行了翻修,1例仍在随访中;异响3例,均未需要翻修。末次随访,平均术后Harris髋关节评分92.4分。在没有翻修的病例中,没有发现骨溶解的证据。结论陶瓷-陶瓷THA平均5年的中期临床结果满意。     

髋关节假体陶瓷内衬碎裂误诊为异位骨化一例报告

患者男,59岁,因双侧髋关节发育不良骨关节炎分别于2002年12月和2003年11月在我院行右侧和左侧全髋关节置换术.术前右侧和左侧Harris髋关节评分分别为42分和48分.均采用陶瓷-陶瓷全髋关节假体(蛇牌,德国),生物型股骨柄,髋臼杯外径48 mm.陶瓷组配为BioloxForte,直径28mm中号陶瓷头.     

The Elite Plus total hip arthroplasty: the need for radiological surveillance

We prospectively studied 217 patients who underwent 234 Elite Plus total hip arthroplasties. At a mean of 6.4 (SD 0.7) years post-operatively, 39 patients had died and 22 were either lost to follow-up or had no radiographs available. Clinical (Oxford hip score) and radiological assessments were performed on 156 patients (168 hip arthroplasties) who had a mean age of 67.7 (SD 9.7) years at operation.In the assessed group, 26 of 159 (16.4%) of femoral stems which had not already been revised and 19 of 159 (11.9%) of acetabular cups were definitely loose. In total, 52 of 168 (31%) of hips had either been revised or had definite evidence of loosening of a component. We could not establish any relationship between clinical and radiological outcomes.Despite the fact that the clinical outcome and rate of revision for the Elite Plus appeared to meet international standards, our findings give us cause for concern. We believe that joint registries should include radiological surveillance in order to provide reliable information about medium-term outcomes for hip prostheses.     

Ceramic-on-Ceramic Total Hip Arthroplasty: Minimum of Six-Year Follow-up Study

Background

This study examines the clinical and radiologic results of ceramic-on-ceramic total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum follow-up of six years.

Methods

We evaluated the results of a consecutive series of 148 primary ceramic-on-ceramic total hip arthroplasties that had been performed between May 2001 and October 2005 in 142 patients. The mean age was 57.2 years (range, 23 to 81 years). The mean follow-up period was 7.8 years (range, 6.1 to 10.1 years). Preoperative diagnosis was avascular necrosis in 77 hips (52%), degenerative arthritis in 36 hips (24.3%), femur neck fracture in 18 hips (12.2%), rheumatoid arthritis in 15 hips (10.1%), and septic hip sequelae in 2 hips (1.4%). Clinical results were evaluated with the Harris hip score, and the presence of postoperative groin or thigh pain. Radiologic analysis was done with special attention in terms of wear, periprosthetic osteolysis, and ceramic failures.

Results

The mean Harris hip score improved from 58.3 (range, 10 to 73) to 92.5 (range, 79 to 100) on the latest follow-up evaluation. At final follow-up, groin pain was found in 4 hips (2.7%), and thigh pain was found in 6 hips (4.1%). Radiologically, all femoral stems demonstrated stable fixations without loosening. Radiolucent lines were observed around the stem in 25 hips (16.9%), and around the cup in 4 hips (2.7%). Endosteal new bone formation was observed around the stem in 95 hips (64.2%) and around the cup in 88 hips (59.5%). No osteolysis was observed around the stem and cup. There were 2 hips (1.4%) of inclination changes of acetabular cup, 2 hips (1.4%) of hip dislocation, 1 hip (0.7%) of ceramic head fracture, and 1 hip (0.7%) of squeaking. The Kaplan-Meier survival rate of the prostheses was 98.1% at postoperative 7.8 years.

Conclusions

The ceramic-on-ceramic total hip arthroplasty produced excellent clinical results and implant survival rates with no detectable osteolysis on a minimum six-year follow-up study. The ceramic-on-ceramic couplings could be a reasonable option of primary total hip arthroplasty for variable indications.     

Total hip arthroplasty for primary osteoarthrosis in younger patients in the Finnish arthroplasty register. 4,661 primary replacements followed for 0-22 years

BACKGROUND: Many studies have found a higher risk of revision after hip arthroplasty in younger patients. We evaluated the population-based survival of total hip arthroplasty (THA) in patients under 55 years of age and the factors affecting survival. METHODS: The Finnish Arthroplasty Register was established in 1980, and 74,492 primary THAs were entered into the register between 1980 and 2001. 4,661 of these were evaluated, all of which had been performed for primary osteoarthrosis on patients under 55 years of age. RESULTS: Proximally circumferentially porous-coated uncemented stems implanted between 1991 and 2001 had a 10-year survival rate of 99 (95% CI 98.5-99.6)% with aseptic loosening as endpoint. The risk of stem revision due to aseptic loosening was higher in cemented stems than in proximally porous-coated (RR 5.5, p < 0.001) or HA-coated (RR 6.6, p = 0.01) uncemented stems implanted during the same period. According to Cox regression analysis of cups implanted 1991-2001, the risk of revision for all-polyethylene cemented cups was 3.0 times as high as that for press-fit porous-coated uncemented cups with aseptic loosening as endpoint (p = 0.01). However, when the endpoint was defined as any revision (including exchange of liner), there was no longer any difference between these two concepts, the 10-year survival rates being 94 (92.1-95.5)% for press-fit porous-coated uncemented cups and 93 (88.5-97.6)% for all-polyethylene cemented cups (p = 0.9). INTERPRETATION: Modern uncemented stems seem to have better resistance to aseptic loosening than cemented stems in younger patients. Thus, for younger patients, uncemented proximally circumferentially porous- and HA-coated stems are the implants of choice. Press-fit porous- and HA-coated uncemented cups may have better endurance against aseptic loosening than cemented cups in younger patients. However, when all revisions (including exchange of liner) are taken into account, the survival of modern uncemented cups is no better than that of all-poly cemented cups.     

Total hip arthroplasty performed without cement in patients with femoral head osteonecrosis who are less than 50 years old

Seventy-two cementless total hip arthroplasties were performed by a single surgeon in 58 patients with the diagnosis of femoral head osteonecrosis. All patients were less than 50 years old (mean, 37 years). The mean follow-up was 84 months with a minimum of 48 months. Good-to-excellent results were maintained at final follow-up in 94% of the hips. Revision rate was 1.5% each for the cups and the stems. Mechanical failure rate was 7.6% for the cups, and 6% for the stems. If the results were analyzed excluding the data from the group of patients who received the Mittelmeier prostheses, the mechanical failure rates for the cups was 0% and for the stems was 4.2%. The probability of survival for the entire series using revision as the endpoint was 96.9% at 11 years. Survival probability decreased to 88.5% if radiographic failures were included. Excluding the Mittelmeier prostheses, survival probability was estimated to be 100% for the cups using both revision and radiographic failures as endpoints; for the stems, the survival probability was 98.0% using revision as the endpoint and 95.8% including radiographic failures. Femoral osteolysis was observed in 1.5% of the hips. No hip had acetabular osteolysis. No measurements of polyethylene wear were attempted in this study. These results appeared superior to total hip arthroplasties done with early cementing techniques in this population of young patients with femoral head osteonecrosis.     

Mixing of components from different manufacturers in total hip arthroplasty: prevalence and comparative outcomes: A study of over 90,000 cases of mixed components in the National Joint Registry for England and Wales

Background and purpose — There have recently been highly publicized examples of suboptimal outcomes with some newer implant designs used for total hip replacement. This has led to calls for tighter regulation. However, surgeons do not always adhere to the regulations already in place and often use implants from different manufacturers together to replace a hip, which is against the recommendations of the Medicines and Healthcare Products Regulatory Agency (MHRA) and the directions of the manufacturers.Patients and methods — We used data from the National Joint Registry of England and Wales (NJR) to investigate this practice.Results — Mixing of components was common, and we identified over 90,000 cases recorded between 2003 and 2013. In the majority of these cases (48,156), stems and heads from one manufacturer were mixed with polyethylene cemented cups from another manufacturer. When using a cemented stem and a polyethylene cup, mixing of stems from one manufacturer with cups from another was associated with a lower revision rate. At 8 years, the cumulative percentage of revisions was 1.9% (95% CI: 1.7–2.1) in the mixed group as compared to 2.4% (2.3–2.5) in the matched group (p = 0.001). Mixing of heads from one manufacturer with stems from another was associated with a higher revision rate (p < 0.001). In hip replacements with ceramic-on-ceramic or metal-on-metal bearings, mixing of stems, heads, and cups from different manufacturers was associated with similar revision rates (p > 0.05).Interpretation — Mixing of components from different manufacturers is a common practice, despite the fact that it goes against regulatory guidance. However, it is not associated with increased revision rates unless heads and stems from different manufacturers are used together.Total hip replacement (THR) has become the standard treatment for end-stage arthritis of the hip, and it is used in a significant proportion of patients with a subcapital fracture of the femoral neck.The majority of manufacturers stipulate in their “instructions for use” that surgeons should use all the components from the same manufacturer, otherwise the surgeons will be working “off label”. However, many surgeons in the UK have matched a femoral component from one manufacturer with an acetabular component from another manufacturer. The surgeons who do this are encouraged by the excellent results that can be achieved following this practice—results that are at least comparable to those obtained when mixing and matching has not been performed. This group of excellent results has usually involved a metal or ceramic head on a polyethylene acetabular component. For example, the NJR 10th Annual Report recorded that between 2003 and 2011 over 6,000 Exeter V40 stems (manufactured by Stryker) were implanted with Elite plus polyethylene cups (manufactured by DePuy), with excellent implant survivorship. In 2013, 11,496 out of 78,479 hip replacements undertaken in England, Wales, and Northern Ireland were “mixed”, i.e. components from different manufacturers were used together. In all, 820 different combinations of stems and cups were used, out of which 487 different combinations were mixed.Recently, the practice of mixing and matching has again come under close scrutiny with the use of large-head “metal-on-metal” devices (LHMOM), where both the femoral head and the acetabular components are made of metal (Telegraph 2014). It is known that LHMOM is associated with a high implant failure rate (Smith et al. 2012), and not only has the bearing surface come under scrutiny but also the “taper junction” where the tapered trunnion of the neck of the femoral implant engages the modular femoral head (Nassif et al. 2014). It has been shown that poorly fitting femoral heads will lead to increased fretting and wear at the taper junction, which has been suggested as a cause for early failure of LHMOM implants (Donaldson et al. 2014, Bolland et al. 2011). It is logical to assume that when components that are made by different manufacturers—with different tolerances and designs—are used together, the fretting will be worse.We investigated the practice of “mixing and matching” of components from different manufacturers in total hip replacement in England and Wales using data from the National Joint Registry. Our hypothesis was that the mixing and matching of components from different manufacturers in primary THR would lead to higher implant revision rates.     

In vivo implant fixation of carbon fiber‐reinforced PEEK hip prostheses in an ovine model

Carbon fiber‐reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough‐textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone‐cement and cement‐stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA‐coated CFR/PEEK implants, even under load‐bearing conditions. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 485–492, 2013     

The use of primary total hip arthroplasty in university hospitals of the European Union

Current practice in primary total hip replacement was investigated by postal survey in 125 university hospitals of the European Union (EU). Most hospitals (78.4%) use a hip register and implant cemented as well as uncemented stems (72.0%) and cups (68.8%). In Scandinavian & Anglo-Saxon countries, 42.9% of the departments implant cemented stems in all their patients, and 16.7% implant cemented cups in all their patients. In these countries, modern cementing techniques are commonly used and therapeutic choices are strongly influenced by hip registers. In Southern Europe, cemented cups have been abandoned in 31.1% and modern cementing techniques are less common. Benelux & Germanic countries have a practice in between. Three cemented (Exeter, Charnley, Lubinus) and three uncemented stems (Zweymüller, ABG, Bi-contact) represent 41.9% and 25.3% of stem types in use. Most departments (70.4%) have adopted alternative bearings. Ceramic-ceramic and metal-metal are both used in almost half of the hospitals. Metal-polyethylene has been abandoned in 15.2%. These trends are taught to new generations of surgeons in the EU and could become common practice in a near future.     

Eleven- to 14-year follow-up results of cementless total hip arthroplasty using a third-generation alumina ceramic-on-ceramic bearing

To analyze long-term survivorship of cementless total hip arthroplasties (THAs) with the third-generation alumina ceramic-on-ceramic bearing, 100 consecutive THAs between 1996 and 1998 were reviewed. One cup and 2 stems were revised due to aseptic loosening. Another cup showed chipping of the acetabular liner at 8 years and required cup revision. The remaining hips showed stable bone ingrowth fixation with no osteolysis at the final follow-up. The 14-year survivorship as the end point of revision was 97.9% for the cup, 97.8% for the stem, and 95.7% for the overall implants, respectively. We conclude that cementless THA with the third-generation ceramic-on-ceramic hip bearing provided an excellent survivorship and eliminated periprosthetic osteolysis for 11 to 14 years.     

Cementless acetabular cup: 6-year follow-up

The aim of this study was to evaluate the long-term outcome of cementless acetabular cups used in primary total hip arthroplasty. From November 1993 to December 1998, we implanted 403 cementless acetabular cups. Here we present a review of 160 patients (97 women) who received cementless acetabular cups with a porous-coated surface. The average postoperative follow-up period was 6 years (range, 4–8 years). The mean age of patients was 68 years for cemented stems (65 hips) and 59 for uncemented stems (95 hips). A total of 104 patients received ceramic-polyethylene components and 56 had ceramic-ceramic components. One patient presented acetabular migration and needed revision after 5 months indicating a failure rate of 0.6%. We believe that our results provides quite good perspectives for future work with this acetabular component. Received: 3 May 2002, Accepted: 10 May 2002