Metasul非骨水泥金属对金属全髋关节置换术在50岁以下患者的应用

背景：全髋关节置换术后的长期使用结果很难在年轻患者中获得。我们对一组活动量大、要求较高、年龄小于50岁的患者使用Metasul金属对金属关节行非骨水泥型全髋关节置换术，并对这组患者的临床和影像学的中期结果进行回顾研究。方法：对62例年龄小于50岁(平均年龄37岁)的患者行70个全髋关节置换术。2例患者(2个髋)因在全髋关节置换术后5年内出现深部感染而行关节切除成形术，予以剔除。余60例患者(68个髋)获得完整的临床和影像学随访，平均随访时间为7年。结果：患髋Harris评分从术前平均49分，提高至末次随访时的95分；56例患者(93％)疗效评价为优。末次随访时影像学检查未发现假体松动表现。1例患者发现一处骨盆局灶性骨溶解，另1例患者有两处小的股骨局灶性骨溶解。出现骨盆局灶性骨溶解的髋关节接受了翻修手术，更换髋臼内衬，对未松动假体周围的骨溶解灶进行植骨。结论：通过对本组患者术后平均7年的随访，可见Metasul金属对金属全髋关节置换术的骨溶解和无菌性松动发生率较低。但有必要进一步随访，以明确与金属对金属关节置换有关的任何长期不良事件。可信水平：治疗性研究，Ⅳ级[病例系列(没有，或历史，对照组)]。进一步可信度参见作者介绍。     

非骨水泥假体髋关节翻修术随访报告

[目的]探讨非骨水泥假体在髋关节翻修术中的临床效果.[方法]对本科1997年11月～2007年8月行非骨水泥人工全髋关节翻修术36例(41髋)患者进行了随访,其中29髋行全髋关节翻修,8髋仅翻修髋臼,4髋仅更换股骨柄.随访X线片上的假体变化情况,分析AAOS、Paprosky骨缺损分类对翻修时假体选择的指导作用,对髋关节行Harris功能评定并分析假体生存率.[结果]24例28髋获得随访,平均随访4.6年(1～11年),患者平均Harris评分由术前的38分(11～76分)增加到末次随访时的88分(60～99分).21髋(75%)假体获得良好稳定性;1髋股骨1区形成2 mm宽的透亮线,临床检查无松动迹象;4髋发生骨溶解并假体移位(股骨1髋,髋臼3髋)而需要再翻修,失败率为12.5 %;8髋发生异位骨化;聚乙烯衬垫年平均磨损量为0.08 mm(0～0.25 mm),磨损率仅与外展角变化存在相关.AAOS分类术前、术中的一致性较Parprosky分类高.分别以任何原因进行了再翻修和影像学证明假体松动作为失败标准,利用Kaplan-Meier生存分析计算假体4.6年存活率分别为89%、81%.[结论]非骨水泥型假体可用于初次髋关节置换术失败的翻修.术中对骨缺损进行细致的评估并选择合适的假体固定,能达到令人较满意的临床效果.     

锶羟基磷灰石生物活性骨水泥应用于髋关节置换的研究

目的探讨锶羟基磷灰石（St-HA）生物活性骨水泥应用于髋关节置换的可行性。方法对Sr—HA生物活性骨水泥的力学特性及其在体应用于髋关节置换及髋关节翻修的生物学特性与聚甲基丙烯酸甲酯（PMMA）骨水泥进行比较及评价。结果Sr-HA生物活性骨水泥与PMMA骨水泥抗压缩强度相似，但其断裂韧度却高于PMMA骨水泥；在体研究表明Sr-HA生物活性骨水泥能与骨形成骨性融合，其与骨界面的剪切力明显大于PMMA骨水泥。结论Sr—HA生物活性骨水泥具有替代PMMA骨水泥应用于髋关节置换的潜力。     

采用抗生素骨水泥假体二期翻修治疗人工髋关节感染

目的探讨采用抗生素骨水泥假体二期翻修治疗人工髋关节感染的疗效。方法自1999年6月至2004年10月,14例初次髋关节置换术后感染患者行二期手术。术前Harris评分平均23分。一期手术中将取出的假体彻底清洗,骨水泥垫临时旷置,关节内引流管引流,术后静脉输入抗生素3周后,改为口服抗生素1个月。二期手术于6个月后进行,植入带抗生素骨水泥型假体。结果14例患者均获得随访,随访时间7～26个月,平均18个月。14例患者术后均无感染复发。术后Harris评分平均70分。结论彻底清创、足够间隔期以及二期手术采用抗生素骨水泥假体是有效控制感染复发的有效措施。     

非骨水泥假体用于髋关节置换后感染翻修7例3．6年随访报告

[目的]探讨用非骨水泥假体对髋关节置换术后感染进行翻修术的效果.[方法]1997年11月～2006年12月,收治7例髋关节置换术后感染患者.以非骨水泥假体对其中4例行全髋关节翻修,2例仅翻修髋臼假体,1例仅更换股骨柄.一期翻修4例,二期翻修3例.随访时应用X线及Harris评分进行评价,并检测患者血沉和C反应蛋白浓度.[结果]7例患者平均随访3.6年(1.5～10.6年),Harris评分由术前的35分(18～63分)提高到末次随访时的89分(60～99分).无1例术后感染复发;1例股骨假体远端穿出股骨皮质而需翻修;末次随访时5例疼痛消失,2例活动时偶有隐痛;2例无跛行,5例轻度跛行;1髋发生Brooker 2级异位骨化;聚乙烯内衬磨损率为0.08 mm/年.无1例出现症状性深静脉血栓或神经损伤.[结论]以非骨水泥假体翻修髋关节置换术后感染,根据个体感染情况选择一期或二期翻修可取得较满意的临床疗效.对固定稳定、与周围骨质间无感染征象的的假体选择不翻修是否可行,有待更多病例的总结.     

金属对金属全髋关节表面置换术研究进展

金属对金属全髋关节表面置换术（metal on metal hip resurfacing arthroplasty,MOM—HRA）从1948年Smith—Petersen首先推出的髋关节表面术演变至今,经过了50多年的变革和发展。在上世纪70年代,由于当时材料抗磨损性能差、磨屑颗粒诱导的骨溶解以及高松动率,使得第1代髋关节表面置换假体被放弃了,但在当时仍被认为是治疗年轻而活跃患者的首选方法。     

非骨水泥长柄假体在髋关节翻修术中的应用

目的回顾性分析非骨水泥全涂层长柄假体在全髋关节翻修术中应用的临床疗效。方法对2006年1月至2011年1月四川大学华西医院收治的采用全涂层长柄假体全髋关节翻修术的53例患者（53髋）进行随访、分析。其中男26例,女27例;年龄49—78岁,平均62岁。股骨假体采用强生（Depuy）公司全涂层长度为165mm的直柄AML假体10例、全涂层165mm的Solution假体19例和203mm带弧度分左右侧的Solution假体24例。比较髋关节术前术后的Harris评分,x线片评价假体柄有无松动下沉及应力遮挡情况。结果53例患者均获随访,随访时间1．8～6．8年,平均4．7年。术前平均Harris评分为37分,最后随访时增加至86分。所有患者均在术后3个月后完全负重,原有髋关节疼痛缓解。在最后随访时,有45例股骨柄假体获得骨长人固定。并发症：术后脱位1例,手法复位后未再发生脱位,术后感染1例,假体柄明显下沉1例,后两例患者行再次翻修术,末次随访假体柄稳定。随访X线片显示多数患者骨质改建,密度增加,未发现假体周围有连续亮带及假体柄下沉的患者。结论复杂的股骨侧翻修手术,应尽可能选择非骨水泥长柄假体。特别是股骨干骺端骨质条件差,中段有骨缺损,近端不能获得牢固固定的病例。术中结合同种异体颗粒骨打压植骨处理股骨中上段中重度骨缺损,中期临床疗效良好,远期效果有待随访。     

非骨水泥型Spotorno股骨柄假体在全髋关节置换术中应用的中远期疗效观察

目的 探讨采用非骨水泥型Spotorno(CLS)股骨柄假体行初次全髋关节置换术(total hip arthroplasty,THA)的中远期疗效.方法 回顾性分析2013年5月至2015年8月我科采用CLS股骨柄假体行THA手术治疗的78例病人的临床资料,其中男45例(48髋),女33例(38髋),年龄为43～81...     

金属对金属全髋关节表面置换术的近期疗效

 目的 分析金属对金属全髋关节表面置换术的近期疗效, 探讨其适应证选择和技术要点。方法 2006 年1 月至2010 年10 月因股骨头坏死、髋关节骨关节炎、髋关节发育不良、强直性脊柱炎接受全髋关节表面置换术104 例(116 髋), 其中男59 例(66 髋), 女45 例(50 髋);年龄16~67 岁, 平均39.7 岁。均采用Conserve Plus 假体, 依据比利时技术标准完成全髋关节表面置换术。术后1 个月、3个月、6 个月、1 年及之后每年随访一次, 摄X 线片并统计Harris 髋关节评分。结果 101 例(112 髋)获得随访, 随访率97.1豫。随访时间9~66 个月, 平均33个月。Harris髋关节评分由术前平均(37.6±6.3)分提高至末次随访时(91.3±5.3)分, 其中优104 髋、良7 髋、差1 髋, 优良率99.1%(111/112)。末次随访时, 髋臼假体外展角36°~55°, 平均42.7°;股骨假体柄干角132°~146°, 平均138.5°。随访期间出现异位骨化2 例(2.0豫, 2/101), 分别为Brooker III型1 例及Brooker II型1 例, 均无症状, 未予处理。术后并发假体脱位1 例(1.0%, 1/101), 经手法复位及卧床1 个月治愈, 未再发生脱位。无股骨颈骨折、假体松动、感染及翻修病例。结论 严格选择手术适应证, 配合精确的手术技术, 金属对金属髋关节表面置换术可获得良好的近期疗效。     

同一设计的骨水泥和非骨水泥股骨假体的效果比较

观察同一设计的骨水泥和非骨水凤骨假体的临床效果。１９９３年１月～１９９５年８月,应用同一设计的骨水泥和非骨水泥股骨人假体,施行２４６髋全髋关节置换。骨水泥组１１７髋,平均随访４．５年;非骨水泥组１２０髋,平均随访４．１４年。骨水泥组Ｍｅｒｌｅ ｄ‘ Ａｕｂｉｇｎｅ评分平均１０．４（５～１２）,优良率８８．９;日常行为评分平均１９．４（７～２４）,优良率８０．３％,无一髋假体松动。非骨水泥组Ｍｅｒｌ     

Cementless Metasul metal-on-metal total hip arthroplasties at 13 years

Second-generation metal-on-metal bearings have been used since the late 1980s as alternative bearings to eliminate aseptic loosening due to polyethylene wear. The aim of the present study was to evaluate the long-term results of a series of Metasul (Zimmer GmbH, Winterthur, Switzerland) metal-on-metal total hip arthroplasty (THA). One hundred forty-nine cementless THAs with a 28-mm Metasul articulation were performed in 111 consecutive patients. The results were retrospectively reviewed at 13 years postoperatively. Clinical and radiographic evaluations and implant survivorship were performed. Seven hips (4.7%) were revised. The overall survivorship with revision for any reason as the end point was 0.94. The average Harris hip score was 91.4. Expansive osteolysis was found adjacent to the stem in 4 hips. Metal wear-related aseptic loosening was not the major reason for failure in our Metasul metal-on-metal THAs. Recurrent dislocation was the main reason for revision in our series.     

Midterm results of Metasul metal-on-metal total hip arthroplasty

We assessed 106 total hip arthroplasties performed with a new metal-on-metal hip system; the patients were monitored for at least 5 years. The average Harris Hip Score of the patients was 39.5 points before surgery and 87.8 points at final follow-up evaluation. Radiographically, the acetabular component was stable in 103 hips and possibly unstable in 3 hips. The femoral component was bone ingrown in 97 hips and stable and fibrous in 9. After surgery, 6 hips dislocated. The polyethylene liner dissociated in one patient. No patient exhibited clear signs of loosening, migration, or osteolysis. Distal femoral cortical hypertrophy was seen in 35.8% of the cases. Survival at the mean follow-up point (6.4 years) was 99.1%. There was no significant difference in serum chromium concentration between metal-on-metal bearings and polyethylene-on-metal bearings (control subjects). This study found that metal-on-metal total hip arthroplasty produces excellent midterm results.     

Large-diameter metal-on-metal cementless total hip arthroplasty in the elderly

To evaluate the clinical effectiveness and complications of large-diameter metal-on-metal prostheses, particularly in the elderly, we performed cementless total hip arthroplasty (THA) using metal-on-metal prostheses with large-diameter femoral heads (mean, 45 mm) in 59 patients (average age, 75.1 years) between January 2004 and December 2005. All procedures were performed using a posterolateral approach and spinal anesthesia. Average follow-up was 65 months. Pre- and postoperative Harris Hip Scores and SF-36 questionnaire results were recorded for all patients to evaluate the level of pain relief, improvement in physical function, and changes in quality of life. Postoperative radiographic images were used to document areas of osteolysis and probable aseptic loosening. Average preoperative Harris Hip Score was 36.1±5.7, compared to 69.4±8.3 at last follow-up (P<.01). Average preoperative SF-36 score was 33.6±7.4, compared to 71.8±6.4 at last follow-up (P<.01). There were no dislocations, aseptic loosening, or revisions. Our findings suggest that metal-on-metal cementless prostheses with large-diameter femoral heads in THA can produce satisfactory results with good durability, a low rate of dislocation and aseptic loosening, and a low incidence of revisions in the short term. The benefits of this technique for elderly patients, especially those with weak muscle power and reduced cognitive function, include avoidance of severe cement-injection complications and early functional recovery.     

Minimum ten-year results of a 28-mm metal-on-metal bearing in cementless total hip arthroplasty in patients fifty years of age and younger

Purpose

Concerns have been raised in relation to metal-on-metal (MoM) articulations with catastrophic soft-tissue reactions due to metal debris. We reviewed how small head MoM articulations perform in primary uncemented total hip arthroplasty (THA) in young patients at a minimum of ten years.

Methods

We retrospectively evaluated the clinical and radiographic results of the first 100 consecutive primary cementless THAs using the 28-mm Metasul MoM articulation in 91 patients younger than 50 years of age at the time of surgery.

Results

After 13 years, survival for the endpoint revision due to any reason was 90.9 % and 98.9 % for revision due to aseptic implant loosening. The cumulative incidence of MoM related revisions was 1.2 %. Small proximal femoral osteolysis was found in 18 % of hips. No acetabular osteolysis or loosening was detected. Two hips showed signs of femoral neck impingement with severe damage to the neck.

Conclusions

Early in the second decade, MoM-associated complications were rare using the 28-mm Metasul articulation, and aseptic loosening was not a major mode of failure in this cohort of young patients.

Level of evidence

Therapeutic Level IV.     

Fixation and osteolysis with Metasul metal-on-metal articulation

The purpose of this study was to report the prevalence of osteolysis and loss of fixation using Metasul metal-on-metal articulation couples. Ninety-two patients with 96 hips with Metasul articulation couples were followed for 5 to 11 years. By patient self-assessment, 89 (93%) patients scored themselves as good or excellent. The occurrence of osteolysis and the grading of fixation were obtained from plain radiographs. The clinical evaluation for these patients was performed by patient self-assessment. With the use of plain radiographs, there was no osteolysis observed in these 96 hips other than calcar resorption (6 hips [6.3%]). All components were fixed, except for 1 loose cup that was revised, and this level of fixation allowed a fair evaluation for osteolysis around well-functioning implants.     

Cementless Metasul metal-on-metal total hip arthroplasty in patients less than fifty years old

BACKGROUND: Durable results of total hip arthroplasty have been difficult to achieve in young patients. We reviewed the intermediate-term clinical and radiographic results in a series of active, higher-demand patients who were less than fifty years old when they underwent cementless total hip arthroplasty with the use of the Metasul metal-on-metal articulation. METHODS: Seventy total hip arthroplasties were performed in sixty-two patients who were younger than fifty years of age (average age, thirty-seven years). Two patients (two hips) had had a resection arthroplasty because of deep infection less than five years postoperatively and were excluded. Sixty patients (sixty-eight hips) were available for complete clinical and radiographic analysis after a mean duration of follow-up of seven years. RESULTS: The mean preoperative Harris hip score of 49 points improved to 95 points at the time of final follow-up; fifty-six patients (93%) had an excellent result. No component was seen to be loose radiographically at the time of final follow-up. Only one focal area of pelvic osteolysis in one patient and two small focal areas of femoral osteolysis in another patient were identified. The hip with focal pelvic osteolysis underwent revision surgery with a liner change and bone-grafting of the osteolytic lesion around a stable component. CONCLUSIONS: At a mean of seven years after arthroplasties with a Metasul metal-on-metal articulation, there was a low rate of osteolysis and aseptic loosening in this group of young patients. However, additional follow-up is necessary to determine any possible long-term deleterious effects associated with this metal-on-metal articulation.     

Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

Background  

Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation.     

Painful metal-on-metal total hip arthroplasty

Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. Serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties were felt to be caused by a combination of musculoskeletal problems.     

Cobalt and chromium concentrations in patients with metal-on-metal and other cementless total hip arthroplasty

We measured the cobalt and chromium concentrations in the serum and urine of 32 patients with current designed metal-on-metal total hip arthroplasty and 43 patients with conventional metal on ultrahigh molecular weight polyethylene (UHMWPE) cementless total hip arthroplasty. The results of our study showed that the serum and urine chromium concentrations increased in 37.5% and 90.6%, respectively, of 32 patients with well-fixed metal articulation (the mean values were 0.09 microg/dl and 2.2 microg/l, respectively) and also increased in 28.6% and 85.7%, respectively, of 7 patients who received metal-on-UHMWPE articulation with loosened acetabular component or stem made of Co/Cr alloy (the mean values were 0.06 microg/dl and 1.6 microg/l, respectively). On the other hand, the serum and urine cobalt concentrations were below the detection limit in all patients.     

骨水泥型与非骨水泥型人工全髋关节置换术的比较

目的评价骨水泥型和非骨水泥型人工全髋关节置换术的术中、术后临床效果。方法对52例患者(54髋)进行人工髋关节置换治疗,其中骨水泥组20例(20髋),非骨水泥组32例(34髋)。术后随访进行髋关节Harris评分、自主功能恢复Parker评分,并观察术后死亡率、假体翻修率及其他并发症的发生情况。结果与骨水泥型组相比,非骨水泥型组术中手术时间短、失血量少,两组差异有显著性(P0.05)。骨水泥组1例患者住院时出现深静脉血栓形成,非骨水泥组有3例住院时出现深静脉血栓形成。骨水泥组置换后3个月,14例患者可独立行走,5例需助步器辅助行走,1例仅能活动(卧床活动);非骨水泥组23例患者可独立行走,9例需助步器辅助行走。置换后1年,在患者髋关节Harris评分和患者自主功能恢复Parker评分方面,两组之间均无显著差异。置换后3年,骨水泥组有4例翻修(均为假体松动),翻修率20%。而非骨水泥组仅有3例翻修(均为假体松动),翻修率9.37%,但两组之间差异无显著性(P0.05)。另外,随访期间骨水泥组有1例患者死亡。结论应用非骨水泥假体可明显降低全髋关节置换术的手术时间和失血量。随访期内骨水泥型和非骨水泥型双动头假体置换术的临床疗效无显著差异。