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Intermediate to Long-Term Follow-up of Cementing Liners into Well-Fixed Acetabular Components.
The Journal of Bone & Joint Surgery ( IF 5.3 ) Pub Date : 2020-08-19 , DOI: 10.2106/jbjs.19.01441
Nicholas A Bedard 1 , Matthew W Tetreault , Arlen D Hanssen , David G Lewallen , Robert T Trousdale , Daniel J Berry , Matthew P Abdel
Affiliation  

Background: 

The cementation of a new liner into a well-fixed acetabular component is common during revision total hip arthroplasty (THA) for many indications, but most commonly for lack of a modern, compatible, highly cross-linked polyethylene (HXLPE) liner. However, little is known about the intermediate-term to long-term durability of this strategy. The purpose of this study was to evaluate the implant survivorship, risk of complications, clinical outcomes, and radiographic results of cementing a new HXLPE liner into a well-fixed acetabular component.

Methods: 

We retrospectively identified 323 revision THAs in which a nonconstrained HXLPE liner was cemented into a well-fixed acetabular component. The mean age at the time of the revision THA was 63 years, and 50% of patients were female. The most common indications for revision THA were polyethylene wear and osteolysis (48%), aseptic femoral loosening (35%), and hip instability (8%). The mean follow-up was 9 years.

Results: 

Polyethylene liner failure occurred in 11 cases (3%). In all cases, the cemented liner dissociated from the acetabular component. At 10 years, the survivorship free from any revision was 80% (95% confidence interval [CI], 75% to 84%) and the survivorship free from any reoperation was 77% (95% CI, 72% to 82%). The most common reason for re-revision was dislocation (45% of reoperations). A dislocation occurred in 17% of cases. Hips that underwent revision for instability were significantly more likely to dislocate compared with hips that underwent revision for liner wear (hazard ratio [HR], 2.3 [95% CI, 1.2 to 4.5]; p = 0.02). Elevated rim or face-changing liners were significantly more likely to dissociate than flat liners (HR, 9.0 [95% CI, 1.2 to 70.6]; p = 0.04).

Conclusions: 

Cementation of a nonconstrained HXLPE liner into a well-fixed acetabular component during revision THA provided durable fixation with only a small number of failures at the cement interface (3%). Instability after this procedure remains a concern, but this is multifactorial in nature. These data support the continued use of this technique, when necessary, during revision THA.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.



中文翻译:

水泥衬板固定在髋臼固定组件的中长期随访。

背景: 

对于许多适应症,在翻修全髋关节置换术(THA)期间,通常将新的内衬粘合到固定良好的髋臼组件中,但最常见的情况是缺少现代的,兼容的,高度交联的聚乙烯(HXLPE)内衬。但是,对该策略的中期至长期持久性知之甚少。这项研究的目的是评估将新的HXLPE内衬固结在固定良好的髋臼组件中的植入物存活率,并发症风险,临床结果以及影像学结果。

方法: 

我们回顾性地确定了323个修订版THA,其中将不受约束的HXLPE内衬粘合到固定良好的髋臼组件中。修订THA时的平均年龄为63岁,并且50%的患者为女性。翻修THA的最常见指征是聚乙烯磨损和骨溶解(48%),无菌性股骨松动(35%)和髋关节不稳定(8%)。平均随访时间为9年。

结果: 

聚乙烯内衬失效发生11例(3%)。在所有情况下,骨水泥衬里都与髋臼组件分离。在10年时,无任何修订的生存率为80%(95%置信区间[CI],从75%至84%),无任何再次手术的生存率为77%(95%CI,从72%至82%)。重新修订的最常见原因是脱位(45%的再次手术)。17%的病例发生脱位。与因衬板磨损而接受翻修的髋关节相比,因不稳定性而接受翻修的髋关节更有可能脱位(危险比[HR],2.3 [95%CI,1.2至4.5]; p = 0.02)。升高的轮辋或换面衬板比平衬板更容易分离(HR,9.0 [95%CI,1.2至70.6]; p = 0.04)。

结论: 

在THA修订版中,将无约束力的HXLPE内衬粘接到固定良好的髋臼组件中,可提供持久的固定,在水泥界面处仅有少量的破坏(3%)。此过程后的不稳定性仍然值得关注,但这本质上是多因素的。这些数据支持在必要时在THA修订版中继续使用该技术。

证据级别: 

治疗级别IV。有关证据水平的完整说明,请参见《作者说明》。

更新日期:2020-08-20
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