H/G非骨水泥人工全髋关节置换术后聚乙烯内杯磨损临床研究

目的 对H/G非骨水泥人工全髋关节置换术后聚乙烯内杯的磨损及髋臼周围骨溶解的情况进行总结.方法 我院1991至1995年共进行58例(65髋)H/G非骨水泥人工全髋关节置换,其中35例(40髋)获得10年以上随访.对这35例(40髋)患者获得随访的病例,采用计算机数字化方法测量髋臼聚乙烯内杯的二维线性磨损.结果 35例40髋均有不同程度的磨损,磨损范围2～8 mm,平均磨损为(0.32±0.31)mm/年.10髋聚乙烯磨损超过6 mm,髋臼假体周围的骨溶解严重,并伴有金属假体的移位,其中5髋聚乙烯内杯完伞磨透,金属股骨头与金属髋臼相接触;5髋聚乙烯内杯磨损严重伴明显骨溶解,内杯松动.2髋聚乙烯内杯脱位.共实施翻修手术12例,包括更换聚乙烯内杯和金属股骨头2例、金属闩杯翻修2例、全髋翻修8例.28髋在髋臼侧发现骨溶解,其中14髋股骨侧亦有骨溶解发生.结论 本组病例所观测到的H/G髋臼聚乙烯内杯的磨损程度超过文献所报道,而且由于磨损产生的大量磨屑,导致假体周围出现明显骨溶解,直接影响到假体的稳定.关节置换术后应定期随访,避免出现严重骨溶解后增加翻修手术的困难.     

Uncemented acetabular components with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: results at five to twelve years.

BACKGROUND: Anterolateral acetabular bone deficiency is one of the technical problems associated with total hip arthroplasty in patients with developmental hip dysplasia. The purpose of this study was to evaluate the results of one method of acetabular reconstruction for hip dysplasia-placement of an uncemented socket in conjunction with a bulk femoral head autograft. METHODS: Forty-four hips in thirty-five patients (twenty-nine female and six male; average age, thirty-nine years) with developmental hip dysplasia were treated with primary total hip arthroplasty with use of an uncemented porous-coated titanium cup fixed with screws and an autogenous bulk femoral head graft. The patients were followed clinically in a prospective fashion for five to 12.3 years (mean, 7.5 years), and radiographs were analyzed retrospectively. RESULTS: Four acetabular components were revised: two, because of severe polyethylene wear and osteolysis; one, because of aseptic loosening; and one, because of fracture of the acetabular shell. The mean Harris hip score for the unrevised hips improved from 51 points preoperatively to 91 points postoperatively. No unrevised socket had definite radiographic evidence of loosening. Forty-three of the forty-four hips had no radiographic evidence of resorption of the graft or had radiographic evidence of resorption limited to the nonstressed area of the graft lateral to the edge of the cup. CONCLUSIONS: This method of reconstruction provided reliable acetabular fixation and appeared to restore acetabular bone stock in patients with developmental hip dysplasia. We use this technique for patients with moderate anterolateral acetabular bone deficiency requiring total hip arthroplasty.     

Fixation and osteolysis in plasma-sprayed hemispherical cups with hybrid total hip arthroplasty

The optimal surface finish on cementless total hip arthroplasty is still a matter of debate. 145 hips in 130 patients with hybrid total hip arthroplasty using a hemispherical, titanium plasma-sprayed cup were followed for an average of 8.5 years. The average age was 63 years, and the average weight was 165 lb. Three hips were revised for polyethylene wear and synovitis/osteolysis. In all 3 cases, the acetabular component remained well fixed. Radiographically, 5 hips had femoral osteolysis, and 5 sockets had osteolysis in zone 2, with 4 in zone 1. There were no cases of progressive lucent lines, and no acetabular components were revised. Plasma-sprayed acetabular components remain durable up to 12 years. Moreover, in cases with wear particle overload and osteolysis, fixation was maintained at revision surgery.     

Titanium and cobalt-chrome cementless femoral stems of identical shape produce equal results

This study of proximal porous-coated stems of identical shape, but with two types of stem materials (Ti alloy or Co-Cr alloy), was done to determine the differences, if any, in these stems in the following parameters: clinical and functional outcomes; the prevalence of thigh pain; the stem alignment and the stem-canal fill; cup position; the degree of periprosthetic bone loss; the prevalence of polyethylene liner wear and osteolysis; the incidence of aseptic loosening of acetabular and femoral components; and complication rates. In the Ti alloy group, there were 60 patients (70 hips) followed up for a mean of 6.4 years (range, 5-7 years) with a mean age at surgery of 45.3 years and a mean weight of 65.7 kg. In the Co-Cr alloy group, there were 60 patients (70 hips) followed up for a mean of 6.6 years (range, 5-7 years) with a mean age at surgery of 45.4 years and a mean weight of 66.8 kg. Harris hip scores did not differ and the prevalence of transient pain in the thigh was 5% with both stems. No acetabular or femoral component had aseptic loosening in either group. Loss of bone density in the calcar region was more severe in the Co-Cr group. The mean polyethylene linear wear per year was 0.15 mm (SD, 0.015) in the Ti group and 0.14 mm (SD, 0.013) in the Co-Cr group. No acetabular or femoral osteolysis was seen in any patient. The clinical and radiographic results of this study did not show any significant differences between the Ti and Co-Cr alloy femoral components; however, the Ti alloy femoral component retained greater periprosthetic bone as compared with a Co-Cr alloy femoral component.     

Similar Wear in Total Hip Arthroplasties with Metallic or Zirconia Femoral Heads

Ceramic femoral heads have been used in an attempt at reducing polyethylene wear of total hip arthroplasties. Clinical results with zirconia femoral heads have been mixed. This study was undertaken to compare the polyethylene wear and incidence of periprosthetic osteolysis in total hip replacements performed using a 28-mm zirconia versus a 28-mm cobalt chromium femoral head. Thirty-five hips with a 28-mm cobalt chromium head and 68 hips with a 28-mm zirconia head were evaluated after a minimum follow-up of 2 years (average, 4.0 years; range, 2.0 to 9.1 years). A monoblock acetabular component was used in all patients. Polyethylene wear was measured in serial radiographs from 58 of the hips utilizing a computer-assisted vector wear technique. Periacetabular osteolysis developed in three patients (two with a zirconia head and one with a cobalt chromium head). The total wear and the annual wear rate were 0.48 mm and 0.11 mm/year for the cobalt chromium heads and 0.53 mm and 0.14 mm/year for the zirconia heads, respectively. We found no benefit with respect to the rate of polyethylene wear or incidence of osteolysis with the use of zirconia femoral heads.     

A comparison of polyethylene wear rates between cemented and cementless cups. A prospective, randomised trial

We selected randomly a consecutive series of 162 patients requiring hip replacement to receive either a cementless, hemispherical, modular, titanium acetabular cup or a cemented, all-polyethylene cup. These replacements were performed by two surgeons in four general hospitals. The same surgical technique was used and a 26 mm metal-head femoral component was used in every case. After exclusions, 115 hips were studied for differences in rates of wear and osteolysis. The mean clinical follow-up was eight years and the mean radiological follow-up, 6.5 years. The cementless cups wore at a mean rate of 0.15 mm per year and the cemented cups at 0.07 mm per year. This difference was significant (p < 0.0001). Our findings in this mid-term study suggest that cementless cups wear more than cemented cups.     

Wear and periprosthetic osteolysis of modular, hemispheric acetabular cups]

Osteolysis associated with polyethylene wear has become one of the most prevalent complications associated with uncemented modular, hemispherical cups. Sixty-five consecutive total hip arthroplasties (ABG i, Howmedica, Stryker) were followed 6-12 years. Cumulative survivorship for the cup was 55.7% after 10 years. There were 20 cups revisions because of polyethylene wear and periprosthetic osteolysis (14 cups) or cup loosening (6 cups). Stability was assessed intraoperatively, 14 cups were revised, whereas 6 new polyethylene cups were cemented into stable metal-back of acetabular component. The average annual wear of revised cups was 0.32 mm. The annual wear of not revised cups was 0.12 mm. The differences were statistically significant (p = 0.002). The mean area of osteolysis was 472 mm2 (SD 257 mm2). There was no significant correlation between wear and area of osteolysis. There was significant correlation R = 0.54, p = 0.014) between time to revision and area of osteolysis. There were no significant differences of wear of polyethylene inlay or area of osteolysis between stable and unstable acetabular cups.     

Polyethylene wear and osteolysis with a new modular titanium acetabular component: results at 7 to 13 years

The first-generation and second-generation modular titanium fiber-metal acetabular components were notable for high rates of pelvic osteolysis and liner dislodgment. This is a prospective, consecutive study of 111 new modular titanium-fiber metal acetabular components with a novel polyethylene locking mechanism at a mean follow-up of 9.5 years (range, 7-13 years). The polyethylene was gamma-irradiated in air in 58 hips and gamma-irradiated in nitrogen in 54 hips. No acetabular component migrated, none were revised, and there was no liner dislodgment. Pelvic osteolysis was seen in only 2 hips. The mean linear wear rate was 0.085 mm/y (range, 0.001-0.3 mm/y). There was a significantly lower rate of wear with polyethylene liners sterilized by gamma-irradiation in nitrogen (P = .0001). The high rate of success and low rate of polyethylene wear and pelvic osteolysis at this length of follow-up may be related to the new design features of this modular acetabular component.     

Wear rates of ceramic-on-ceramic bearing surfaces in total hip implants: a 12-year follow-up study.

A retrospective clinical and radiographic analysis was performed on 58 patients (60 hips; mean age at time of surgery, 45.2 years) at a minimum of 10-year follow-up (mean, 12.7 years) after total hip replacement using a ceramic-on-ceramic hearing total hip implant (Autophor, Smith and Nephew, Memphis, TN). Mean wear rate at final follow-up was 0.21 mim, averaging 0.016 mm/y. There were no cases of periprosthetic osteolysis in the acetabuulum or femur. For the unrevised components, there were 3 (5%) cases of protrusio acetabuli and 4 (7%) cases of acetabular component loosening. On the femoral side, 78.3% had distal pedestal formation, and 83% had greater than 2 mm implant-bone radiolucencies in more than 5 Gruen zones as a result of gross motion of the stem. Despite radiographic evidence of implant loosening, this hard bearing articulation functioned well in vivo for more than 12 years with remarkably low wear--approximately one tenth the rate reported for metal-on-polyethylene total hip bearings.     

Long-term results of uncemented acetabular cups with an ACS polyethylene liner. A 14–16-year follow-up study

We assessed the clinical and radiographic results of 40 porous-coated acetabular cups with an Acetabular Cup System polyethylene liner over a minimum 14-year follow-up. Femoral head penetration was estimated using a software package. Fifteen cups were revised, 11 due to polyethylene liner rupture. All cups but two were radiographically stable, and 11 hips showed acetabular osteolysis. The overall femoral head penetration rate in hips without liner fracture with reference to the early penetration point was 0.1188+/-0.070 mm per year. Polyethylene liner fractures were associated with higher early femoral head penetration (P<0.0001) and a vertical cup position (P=0.0016). The 14-year survival without cup revision for any reason was 63.9%, 71.8% with no ACS polyethylene liner fracture and 65.3% with no acetabular osteolysis. Most cups showed a good clinical outcome in general, but major Acetabular Cup System liner failure and osteolysis were frequent. Patients with the ACS cups still in place should be monitored closely.     

全髋关节置换术治疗成人髋关节发育不良继发骨关节炎五年以上随访研究

目的 评价全髋关节置换术(total hip arthroplasty,THA)在成人髋关节发育不良(develop-mental dysplasia of the hip,DDH)继发骨关节炎患者中的疗效,回顾性分析该类患者THA术后5年以上的临床疗效及其影响因素.方法 对2000年2月至2002年7月在我院采用THA治疗DDH继发骨关节炎的患者55例(69髋)进行术后随访.临床评估以Harris评分为标准.影像学评估根据随访骨盆平片及患髋正、侧位X线片,观察髋臼、股骨假体位置及其周围骨质变化,测量内衬磨损率.假体生存率采用Kaplan-Meier方法进行分析,以任何原因的臼杯、股骨柄翻修或影像学假体明显松动为随访终点.结果 截至随访终点,共45例(57)髋获得5年以上随访,平均随访时间69个月,随访率为81.8%.Harris评分由术前的(46.19±18.01)分提高至末次随访时的(91.78±3.52)分,尚无假体翻修病例.聚乙烯内衬平均磨损率为(0.27±0.14)mm/年.5髋髋臼侧发生骨溶解,8髋股骨侧近端发生骨溶解.Kaplan-Meier分析假体总生存率为1.0(95%可信区间,0.98～1.00).结论 THA治疗DDH继发骨关节炎5年以上随访的影像学表现及临床效果尚可,但存在较高的聚乙烯磨损率及骨溶解发生率,对于年轻、活动量大的DDH患者,THA手术时应选择新型耐摩擦界面假体.DDH患者的定期随访尤为重要,可甲期发现骨溶解,及时给予相应的治疗.     

Clinical and radiographic evaluation of the Harris-Galante cup: incidence of wear and osteolysis at 7 to 9 years follow-up

A retrospective evaluation of the clinical and radiographic results of the Harris-Galante acetabular cups was performed in 112 patients with 127 total hip arthroplasties. Patients with 14 hips had died, and patients with 20 hips were lost to follow-up. A total of 82 patients with 93 hips was available for follow-up. There were 67 men and 45 women. The mean follow-up was 87 months (range, 48-113 months). There were a total of 9 revisions: 2 for recurrent dislocations, 1 for a loose cup, and 6 for wear and osteolysis. Radiographic evaluation demonstrated that 22 (24%) hips had periacetabular osteolysis, and 16 of these 22 (73%) were associated with the screws. Twenty-two hips (23%) demonstrated osteolytic lesions around the femoral stem. Mean femoral head displacement was of 1.00 mm (range, 0.40-4.5 mm) with a rate of 0.16 mm/yr (range, 0.05-0.44 mm/yr). The Harris-Galante socket has maintained a low implant failure rate at intermediate term, even in these young patients. As follow-up increases, wear of the polyethylene and periprosthetic osteolysis may become growing concerns.     

The Harris-Galante total hip arthroplasty: a minimum 8-year follow-up study

A total of 93 Harris-Galante Porous I (HGP- I) prostheses were analyzed with a mean follow-up of 10.2 years. Thigh pain (28 hips) correlated with unstable fixation (P<.005), female gender (P<.045), young age (P<.05), poor distal femoral fill (P<.002), subsidence (P<.0001), and osteolysis (P<.05). Thirteen stems and 6 metallic shell cups were revised. Kaplan-Meier analysis showed 13-year survival rates of 92.5% +/- 5.8% for the metallic shell cup, 79.7% +/- 13% for the HGP-I cup, and 76.3% +/- 14.0% for the stem. Five polyethylene liners were changed because of wear >1 mm. Radiographic loosening occurred in 8 cups. Radiographic bone ingrowth was present in 54 stems, stable fibrous fixation was present in 24 stems, and unstable fixation was present in 15 stems. The mean polyethylene wear was 0.17 mm/y. Eleven hips (11.8%) had acetabular osteolysis, and 24 (25.8%) had femoral osteolysis, the latter being more frequent in unstable stems (P<.007). The HGP-I metallic cup shows better clinical and radiographic results than the stem, which frequently is associated with pain, unstable fixation, and osteolysis. Excessive polyethylene wear is frequent.     

Total hip replacement with a cementless acetabular component and a cemented femoral component in patients younger than fifty years of age

BACKGROUND: We have been using hybrid total hip arthroplasty (a cementless acetabular component and a cemented stem) in young patients. The purpose of this study was to determine the prevalence of aseptic loosening, polyethylene wear, and osteolysis after the use of this technique. METHODS: We studied a prospective consecutive series of sixty-four primary hybrid total hip replacements in fifty-five patients younger than fifty years old. There were forty-three men and twelve women; the average age at the time of the index operation was 43.4 years. The average duration of follow-up was 9.4 years. We used a cementless acetabular component without screw-holes and a cemented femoral component with a 22-mm head in all hips. Clinical follow-up with use of Harris hip ratings and radiographic follow-up were performed at six weeks; at three, six, and twelve months; and yearly thereafter. The sequential annual linear and volumetric wear rates were measured, and bone-remodeling and osteolysis were assessed. RESULTS: The mean preoperative Harris hip score was 44 points, which increased to 95 points at the time of final follow-up. No hip had aseptic loosening. One hip (2%) was revised because of late infection. The average linear wear (and standard deviation) was 0.96 +/- 0.066 mm, with an average annual rate of 0.096 +/- 0.013 mm. The average volumetric wear was 364.7 +/- 25.2 mm (3), with an average annual rate of 43.4 +/- 3.5 mm (3). Six hips (9%) had an osteolytic lesion of <1 cm in diameter in the calcar femorale (zone 7). CONCLUSIONS: Our results show that a hybrid arthroplasty with a cementless acetabular component and a smooth cemented femoral component (Ra, 0.6 mm) is effective for primary total hip replacement in young patients. Although there was no aseptic loosening and a low prevalence of osteolysis at the latest follow-up evaluation, the high rates of linear and volumetric wear of the polyethylene liner in these young patients remain a concern.     

Highly Cross-Linked Polyethylene in Total Hip Arthroplasty for Osteonecrosis of the Femoral Head : A Minimum 5-Year Follow-Up Study

We evaluated 162 hips with osteonecrosis of the femoral head that had undergone THA using highly cross-linked polyethylene liner after a minimum follow-up of 5 years. Neither femoral nor acetabular components displayed radiographic evidence of mechanical loosening or osteolysis, and no components had been revised at the latest follow-up. The mean rate of linear liner wear was 0.038 mm/year. Univariate regression analysis did not demonstrate that age, gender, weight, activity level or cup inclination had any influence on penetration. While the long term effects of altered mechanical properties of highly cross-linked PE remain unknown, the clinical and radiographic results at a minimum of 5 years are promising for this high-risk population.     

Arthopor 2 acetabular component with screw fixation in primary hip arthroplasty: A 7- to 9-year follow-up study

The first 100 consecutive primary hip arthroplasties with the Arthopor 2 acetabular component (Joint Medical Products, Stamford, CT) with supplemental screw fixation performed by the senior author were prospectively studied. The mean patient age was 57 years. Seventy-seven cemented and 23 cementless stems were placed, with 32-mm femoral heads used in most of the patients. Eighty-six hips were reviewed at 7–8.8 years (mean, 7.8 years). The mean Harris hip score at final follow-up evaluation was 94 points. No cups have been revised, although 2 cups in patients with radiation osteonecrosis were loose radiographically. One patient underwent revision of a severely worn liner. Despite a relatively high mean linear wear rate of 0.27 mm/y (range, 0.13–0.57 mm/y), no radiographic evidence of pelvic osteolysis was seen. The Arthopor 2 cup performed well with respect to pelvic osteolysis, despite the presence of substantial polyethylene debris. The relatively high polyethylene wear rate is attributed in part to the younger patient population and the use of 32-mm femoral heads paired with thin polyethylene liners.     

Developmental hip dysplasia treated with total hip arthroplasty with a straight stem and a threaded cup

BACKGROUND: Operative strategies to overcome the anatomical anomalies in patients with osteoarthritis secondary to developmental dysplasia of the hip remain controversial. The objective of this study was to determine the outcomes of total hip replacement with a grit-blasted cementless threaded cup and a cementless straight stem in patients with developmental dysplasia. METHODS: Ninety-three patients with developmental hip dysplasia who had been treated with a total of 121 cementless total hip arthroplasties were clinically assessed at a mean of 9.3 years. The acetabular reconstruction was done with a cementless threaded cup, which was medialized to ensure that at least one thread was anchored in the bone in order to achieve good primary stability. All radiographs were analyzed retrospectively. RESULTS: Kaplan-Meier survivorship analysis, with radiographic evidence of aseptic loosening as the end point, predicted a survival rate of 97.5% for the acetabular component and 100% for the femoral stem at 9.3 years. The average Harris hip score for the unrevised hips improved from 34.0 points preoperatively to 84.1 points at the latest follow-up evaluation. The average total volume of polyethylene wear at the time of final follow-up was 73.6 mm(3). CONCLUSIONS: These wear and loosening rates demonstrate that very good results were achieved in this relatively young patient population when the hip joint center had been properly restored, even when a small cup with a thin polyethylene liner had been used.     

全髋关节置换术后聚乙烯内衬磨损的测量及其临床意义

目的以计算机数字化方法计测人工全髋假体二维线性磨损,并探讨磨损程度与长期随访结果的临床相关性。方法利用计算机软件测量股骨头中心相对于髋臼中心的矢量位移,来决定关节面磨损的大小和方向。对 104髋非骨水泥型人工假体进行磨损计测、临床和放射学检查,平均随访时间为 8.4年。结果 14髋股骨或髋臼假体松动,假体松动率为 13.5％。平均线性磨损值为 1.14 mm,磨损率为 0.15 mm/年。聚乙烯磨损与髋臼侧骨溶解及假体松动相关 (P< 0.05)。多因素回归分析未发现磨损和患者年龄、体重、髋杯大小和外展角、活动量水平以及 Harris髋关节评分的相关关系。结论此方法可应用于各种不同设计的人工假体内衬的二维磨损测量。磨损与骨溶解显著相关,并与假体松动互为因果。因此,在进行临床随访、放射学观察的同时,磨损情况也是全面评价全髋置换术临床结果的一个重要指标。     

High osteolysis and revision rate with the hydroxyapatite-coated ABG hip prostheses: 65 hips in 56 young patients followed for 5-9 years

BACKGROUND: There are few reports on the outcome of uncemented HA-coated cups in young patients. PATIENTS: I evaluated the 7-year (5-9) results of HA-coated hip prosthesis (ABG, Stryker) in a consecutive series of 65 primary arthroplasties on 56 patients (mean age 44 years). 2 patients were lost to follow-up and 3 died. RESULTS: The cumulative survival rate with revision for any reason as endpoint at 9 years was 98% (95% CI, 96-100) for the stem, 69% (61-77) for the acetabular metal backing, and 59% (50-67) for the polyethylene liner. 15 of 65 cups were revised on average 6 years after the primary operation and 3 more are planned. Revisions were done in 3 hips because of loosening and migration of the cup, and in 12 hips because of wear and progressive osteolysis around stable components. Only hips with migration had clinical symptoms. Visual inspection of polyethylene liners revealed wear of the articulation in all cases, loosening of the locking mechanism in 10 cases and nonarticular surface deformity in 7 hips. All original stems are in situ although femoral osteolysis was seen in 12 cases and 1 hip was reoperated because of periprosthetic traumatic fracture. Despite the high revision rate, the clinical improvement was good: the average pre- and postoperative Harris Hip Scores at the most recent follow-up were 41 and 90, respectively. INTERPRETATION: While the results on the femoral side were good, the survival rates of the acetabular cups were poor and we stopped using ABG I hip prostheses.