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.     

Cementless hemispheric porous-coated sockets implanted with press-fit technique without screws: average ten-year follow-up

BACKGROUND: Press-fit implantation of a porous-coated hemispheric acetabular component without screws is an option for primary total hip replacement. The purpose of the present study was to evaluate the results of this technique after an average duration of follow-up of ten years to determine if there was any loss of fixation or increase in osteolysis over time. METHODS: From June 1988 to November 1990, 132 primary total hip replacements were performed with a porous-coated socket that was implanted with use of a press-fit technique. Twenty-two hips were excluded because the patient had died or had been lost to follow-up, leaving 110 hips (103 patients) available for inclusion in the study after an average duration of follow-up of 10.2 +/- 1.0 years. The average age of the patients at the time of operation was 60.7 years (range, 23.7 to 86.2 years). Radiographs were evaluated with regard to initial gaps, radiolucent lines, migration, polyethylene wear, and osteolysis. Kaplan-Meier survivorship analysis was performed to calculate the rate of survival of the acetabular component. RESULTS: One hip (0.9%) had revision of the socket because of aseptic loosening, and four hips (4%) had revision of a stable socket. With the numbers available, the presence of gaps on the initial postoperative radiographs was not associated with the occurrence of radiolucent lines (p = 0.039). Pelvic osteolysis was seen in four hips, with an average time to radiographic appearance of six years. Increased wear was directly related to an abduction angle of >40 degrees. The twelve-year survival rate was 99.1% with revision because of failure of fixation of the metal shell as the end point, 95.3% with revision for any reason as the end point, and 79.6% with exchange of the liner as the end point. CONCLUSIONS: The fixation of this press-fit socket did not deteriorate over time and was associated with a low rate of osteolysis. The most common reasons for reoperation were wear and dissociation of the polyethylene insert.     

Primary total hip arthroplasty with a porous-coated acetabular component. A concise follow-up of a previous report

We previously reported the seven-to-ten-year results of the use of a porous-coated acetabular metal shell in a consecutive series of 204 primary total hip arthroplasties. In the present study, we evaluated the longer-term outcomes of these arthroplasties, at fifteen to eighteen years. One hundred and thirty-six (96%) of the 142 hips available for study retained the original acetabular metal shell. Three of the 142 metal shells failed secondary to aseptic loosening. Ten hips (7%) required a change of the modular acetabular liner because of excessive wear or for the treatment of osteolysis. The fifteen-year rate of survival of the metal shell, with failure defined as revision because of loosening or radiographic evidence of loosening, was 99%. The rate of survival of cementless acetabular reconstructions was excellent at fifteen years, although osteolysis and reoperations were noted to occur much more frequently as the duration of follow-up increased. The majority of the complications were related to wear of the polyethylene liner.     

The Harris-Galante Porous acetabular component at intermediate follow-up

Outcome of the acetabular component in 90 consecutive primary noncemented total hip arthroplasties (THAs) was prospectively studied. The acetabular cup consisted of a hemispherical titanium alloy shell with a titanium fiber-mesh porous coating and a modular polyethylene liner (Harris-Galante Porous-1, Zimmer, Warsaw, Ind). The cup was implanted using line-to-line reaming with adjunctive dome screw fixation. The femoral component consisted of a titanium alloy stem with titanium fiber-mesh porous coating and a 28-mm cobalt-chrome modular head. Mean patient age was 53 years (range: 27-75 years); male:female ratio was 48:42; and mean follow-up was 6 years (range: 4.5-8 years). One acetabular component was revised for aseptic loosening. Of 81 unrevised hips available for follow-up, mean Harris hip score was 57 preoperatively and 96 at final follow-up (72% excellent, 15% good, 1 3% fair, and none poor). Of 61 unrevised hips with adequate radiographic follow-up, radiographic failure (complete periprosthetic radiolucency) was evident in 3 (4.9%) and periacetabular osteolysis in none. Radiographic failure did not correlate with poor clinical outcome. Linear polyethylene wear rate (mean: 0.13 mm/year) did not correlate with age, gender, weight, outcome, or cup abduction angle, but did correlate with the presence of femoral periprosthetic osteolysis (0.18 mm/year with femoral osteolysis versus 0.11 mm/year without; P= .01). This series of porous-coated hemispherical cups demonstrated excellent intermediate-term clinical and radiographic outcome, comparable with similarly favorable results reported by the prosthesis designers. A potentially adverse effect of polyethylene wear on the longevity of a THA was supported by a positive correlation between polyethylene wear rate and femoral osteolysis.     

Second-generation cementless total hip arthroplasty. Eight to eleven-year results.

BACKGROUND: Second-generation cementless femoral components were designed to provide more reliable ingrowth and to limit distal osteolysis by incorporating circumferential proximal ingrowth surfaces. We examined the eight to eleven-year results of total hip arthroplasty with a cementless, anatomically designed femoral component and a cementless hemispheric acetabular component. METHODS: Ninety-two consecutive primary total hip arthroplasties with implantation of a femoral component with a circumferential proximal porous coating (Anatomic Hip) and a cementless hemispheric porous-coated acetabular component (Harris-Galante II) were performed in eighty-five patients. These patients were prospectively followed clinically and radiographically. Six patients (seven hips) died and five patients (seven hips) were lost to follow-up, leaving seventy-four patients (seventy-eight hips) who had been followed for a mean of ten years (range, eight to eleven years). The mean age at the time of the arthroplasty was fifty-two years. RESULTS: The mean preoperative Harris hip score of 51 points improved to 94 points at the time of final follow-up; 86% of the hips had a good or excellent result. Thigh pain was reported as mild to severe after seven hip arthroplasties. No femoral component was revised for any reason, and none were loose radiographically at the time of the last follow-up. Two hips underwent acetabular revision (one because of dislocation and one because of loosening). Kaplan-Meier survivorship analysis was performed with revision or loosening of any component as the end point. The ten-year survival rate was 96.4% +/- 2.1% for the total hip prosthesis, 100% for the femoral component, and 96.4% +/- 2.1% for the acetabular component. Radiolucencies adjacent to the nonporous portion of the femoral component were seen in sixty-eight (93%) of the -seventy-three hips with complete radiographic follow-up. Femoral osteolysis proximal to the lesser trochanter was noted in four hips (5%). No osteolysis was identified distal to the lesser trochanter. Periacetabular osteolysis was identified in twelve hips (16%). Five patients underwent exchange of the acetabular liner because of polyethylene wear. CONCLUSIONS: This second-generation cementless, anatomically designed femoral component provided excellent clinical and radiographic results with a 100% survival rate at ten years. The circumferential porous coating of this implant improved ingrowth and prevented distal osteolysis at a mean of ten years after the arthroplasty.     

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.     

Primary total hip arthroplasty with a cementless porous-coated anatomic total hip prosthesis: 10- to 12-year results of prospective and consecutive series.

We performed a prospective study in 108 consecutive patients (116 hips) who were followed for a minimum of 10 years (10-12 years) after primary total hip arthroplasty using an uncemented porous-coated anatomic (PCA) hip prosthesis. The average age of the patients at operation was 48.4 years (range, 19-85 years), and the diagnosis was avascular necrosis of the femoral head in 46 hips, neglected femoral neck fracture in 27, osteoarthrosis secondary to childhood pyogenic arthritis in 24, childhood tuberculous arthritis in 5, and miscellaneous in 14. The average preoperative Harris Hip Score was 55 points, which improved to 87 points at 11 years. Seventy-five hips (65%) were excellent, 11 (9%) were good, and 30 (39%) were poor. The overall rate of revision was 15% (17 of 116 hips). The rate of revision of the femoral component was 11% (13 of 116 hips), and the rate of revision of the acetabular component was 15% (17 of 116 hips). The prevalence of thigh pain was 28% at 11 years. The increase in the incidence of aseptic loosening of the femoral component was found to explain the high incidence of severe thigh pain at 11 years' follow-up. At 11 years, there was femoral osteolysis in 69 hips (59%) and acetabular osteolysis in 65 hips (56%). At 6 years, 20 hips (17%) showed definite wear of the polyethylene liner. At 11 years, 81 hips (70%) showed definite wear of the polyethylene liner. Because the complication rate of the PCA hip prosthesis with respect to loosening, osteolysis, and excessive wear in the polyethylene liner is high, we abandoned the use of this implant.     

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.     

Clinical performance of a Durasul highly cross-linked polyethylene acetabular liner for total hip arthroplasty at five years

BACKGROUND: Highly cross-linked polyethylene is currently the most common articulation surface used for total hip arthroplasty. The hypothesis of the present study was that the Durasul highly cross-linked polyethylene acetabular liner would have less wear at five years than would a conventional polyethylene liner used in association with the same total hip replacement system. METHODS: Forty-three consecutive patients (fifty hips) underwent total hip replacement with an uncemented titanium porous-coated metal cup and a Durasul liner that was mated with a 28-mm cobalt-chromium femoral head. Thirty-one patients (thirty-seven hips) were followed for at least five years. Thirty-five other patients (thirty-seven hips) underwent total hip arthroplasty with the same system but with a conventional polyethylene liner, and these patients also were followed for five years. Clinical assessment was performed with use of the Harris hip score and a patient self-assessment examination. Radiographic analysis included measurements of acetabular component position, fixation, and osteolysis. Femoral head penetration of the Durasul liners was compared with that of the conventional liners. RESULTS: The clinical results as determined on the basis of Harris hip scores and patient self-assessment examinations did not differ between the Durasul group and the control group. The mean bedding-in penetration was 0.054 +/- 0.07 mm for the Durasul group and 0.059 +/- 0.154 mm for the control group. The subsequent penetration, with elimination of the bedding-in wear, resulted in a linear wear rate of 0.029 +/- 0.02 mm per year for the Durasul group, compared with 0.065 +/- 0.03 mm per year for the control group (p < 0.005). The annual penetration at one and five years was 0.074 mm and 0.011 mm, respectively, for the Durasul group, compared with 0.151 mm and 0.04 mm, respectively, for the control group. CONCLUSIONS: While the qualitative wear pattern of the highly cross-linked polyethylene liner was the same as that of the conventional polyethylene liner, the annual linear wear rate was 45% of that seen with the conventional polyethylene liner. Therefore, we believe that these early data support the continued use of this highly cross-linked polyethylene liner for total hip arthroplasty.     

Results of the anatomic medullary locking total hip arthroplasty at a minimum of twenty years. A concise follow-up of previous reports

Between October 1982 and December 1984, the senior author performed 223 total hip arthroplasties in 215 patients with use of the anatomic medullary locking hip stem and TriSpike cup. We now report on 119 of these hips at a mean of 22.0 years (range, 20.0 to 25.0 years) after surgery. Of the fifty-six hips with minimum twenty-year follow-up radiographs and the original acetabular component, seventeen (30.4%) had pelvic osteolytic lesions measuring larger than 1.5 cm(2). Of the sixty-eight hips with twenty-year radiographs and the original anatomic medullary locking stem, twenty-five (36.8%) had femoral osteolytic lesions measuring larger than 1.5 cm(2). Acetabular osteolysis was significantly associated with cup loosening (p = 0.006), but the presence of femoral osteolysis was not associated with stem loosening. Kaplan-Meier analysis, with revision for any reason as the end point, revealed that the survival rate at twenty years was 85.8% +/- 5.2% for the acetabular shell and 97.8% +/- 2.2% for the stem. The most common reoperation was polyethylene exchange because of wear or osteolysis.     

The Harris-Galante porous-coated, hemispherical, polyethylene-lined acetabular component in patients under 50 years of age: a 12- to 16-year review

We have reviewed 70 Harris-Galante uncemented acetabular components implanted as hybrid hip replacements with cemented stems between 1991 and 1995 in 53 patients whose mean age was 40 years (19 to 49). The mean follow-up was for 13.6 years (12 to 16) with no loss to follow-up. We assessed the patients both clinically and radiologically. The mean Oxford hip score was 20 (12 to 46) and the mean Harris hip score 81 (37 to 100) at the final review. Radiologically, 27 hips (39%) had femoral osteolysis, 13 (19%) acetabular osteolysis, and 31 (44%) radiolucent lines around the acetabular component. Kaplan-Meier survival curves were constructed for the outcomes of revision of the acetabular component, revision of the component and polyethylene liner, and impending revision for progressive osteolysis. The cumulative survival for revision of the acetabular component was 94% (95% confidence interval 88.4 to 99.7), for the component and liner 84% (95% confidence interval 74.5 to 93.5) and for impending revision 55.3% (95% confidence interval 40.6 to 70) at 16 years. Uncemented acetabular components with polyethylene liners undergo silent lysis and merit regular long-term radiological review.     

Cementless total hip replacement using second-generation components: a 12- to 16-year follow-up

We reviewed 123 second-generation uncemented total hip replacements performed on 115 patients by a single surgeon between 1993 and 1994. The acetabular component used in all cases was a fully porous-coated threaded hemispheric titanium shell (T-Tap ST) with a calcium ion stearate-free, isostatically compression-moulded polyethylene liner. The titanium femoral component used was a Taperloc with a reduced distal stem. No patient was lost to follow-up. Complete clinical and radiological follow-up was obtained for all 123 hips at a mean of 14 years (12 to 16). One femoral component was revised after a fracture, and three acetabular components for aseptic loosening. No additional femoral or acetabular components were judged loose by radiological criteria. Mild proximal femoral osteolysis was identified in two hips and minor acetabular osteolysis was present in four. The mean rate of penetration of the femoral head was 0.036 mm/year (0.000 to 0.227). These findings suggest that refinements in component design may be associated with excellent long-term fixation in cementless primary total hip replacement.     

Long-Term Results of Porous-Coated Anatomic Total Hip Arthroplasty for Patients With Osteoarthritis of the Hip

Between 1986 and 1997, 136 porous-coated anatomic (PCA) total hip arthroplasties were performed for patients with osteoarthritis of the hip, and data were available for 60 hips at final follow-up (mean follow-up, 15.2 years). Of these, 18 hips had undergone revision: 12 for the acetabular component, 10 for the femoral component, and 4 for both components. Survival rate at 23 years postoperatively was 60% for the acetabular component and 82% for the femoral component. Multivariate Cox proportional hazards regression showed that annual polyethylene wear rate, size, and abduction angle of the acetabular component were significantly associated with acetabular component revision surgery, and that annual polyethylene wear rate and filling ratio of the femur were associated with femoral component revision surgery.     

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。     

Precoated femoral component in total hip arthroplasty. Results of 5- to 9-year followup.

One hundred nineteen consecutive primary hybrid total hip arthroplasties with a precoated femoral component were performed by one surgeon in 100 patients and followed up prospectively. Ninety-eight hips in 82 patients (mean age, 67 years) were evaluated clinically and radiographically at a mean of 6.5 years (range, 5-9 years). The hips were evaluated clinically using the Harris hip score, and radiographs were evaluated for femoral cement grade, loosening, and osteolysis. Ninety-five hips remained in place at the most recent followup. Two femoral components were revised for definite loosening, and one well fixed femoral component was removed because of late hematogenous infection. Excluding the three hips that were revised, the clinical result was excellent or good in 79 hips (83%), fair in 12 hips (13%), and poor in four hips (4%). All other femoral components were well fixed. There were defects of the cement mantles (C1 and C2) in 90 hips. No femoral component had a stem and cement radiolucent line. Focal femoral osteolysis was seen in only two hips. One acetabular component was removed at 5 years because of late hematogenous infection. One acetabular component had asymptomatic migration. The remaining 96 acetabular components were well fixed. Focal acetabular osteolysis was present in four hips. The mean linear polyethylene wear rate was 0.06 (+/- 0.05) mm per year. In contrast to other reports of early failure and osteolysis, the use of a precoated femoral component in this study did not adversely affect the fixation of hybrid total hip arthroplasty, with definite failure of only 2% (two of 98) of the femoral components.     

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.     

Cementless alumina-on-alumina total hip arthroplasty in patients younger than 50 years: a 5-year minimum follow-up study

Sixty-seven patients (78 hips) who were younger than 50 years underwent cementless total hip arthroplasty using a porous-coated acetabular cup, an alumina liner, a 28-mm alumina head, and a proximally porous-coated femoral stem. One patient (1 hip) died and 2 patients (3 hips) were lost to follow-up. The remaining 64 patients (74 hips) were followed for 5 to 6 years. Their mean age at the index operation was 37 years. The mean Harris hip score was 94 points at the time of final follow-up. Four patients (4 hips) had mild thigh pain. All acetabular and femoral components were bone-ingrown, and neither pelvic nor femoral osteolysis was identified. No fracture of the ceramic liner or head was identified. Wear of the ceramic components was undetectable in 27 hips in which measurement was possible.     

High placement of noncemented acetabular components in revision total hip arthroplasty. A concise follow-up, at a minimum of fifteen years, of a previous report

We previously reported the average ten-year results associated with the use of porous-coated noncemented acetabular shells that were placed at a high hip center at the time of revision total hip arthroplasty in thirty-four patients (thirty-six hips) with severe acetabular bone loss. We now report the average 16.8-year results for twenty-one patients (twenty-three hips). Of the original cohort of forty-four patients (forty-six hips), thirty-nine patients (forty-one hips; 89%) retained the shell. Two shells (4.3%) were revised because of aseptic loosening, and three (6.5%) were revised because of infection. Six femoral components were revised because of femoral osteolysis, and seven were revised because of aseptic loosening without osteolysis. On the basis of our results after an average duration of follow-up of 16.8 years, we believe that the placement of an uncemented acetabular component at a high hip center continues to be an excellent technique for revision total hip arthroplasty in selected patients with severe acetabular bone loss.