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Modified acetabular component liner designs are not superior to standard liners at reducing the risk of revision : an analysis of 151,096 cementless total hip arthroplasties from the German Arthroplasty Registry.
The Bone & Joint Journal ( IF 4.6 ) Pub Date : 2022-07-01 , DOI: 10.1302/0301-620x.104b7.bjj-2021-1791.r1
Paula Krull 1 , Arnd Steinbrück 2 , Alexander W Grimberg 2 , Oliver Melsheimer 2 , Michael Morlock 3 , Carsten Perka 1
Affiliation  

AIMS Registry studies on modified acetabular polyethylene (PE) liner designs are limited. We investigated the influence of standard and modified PE acetabular liner designs on the revision rate for mechanical complications in primary cementless total hip arthroplasty (THA). METHODS We analyzed 151,096 primary cementless THAs from the German Arthroplasty Registry (EPRD) between November 2012 and November 2020. Cumulative incidence of revision for mechanical complications for standard and four modified PE liners (lipped, offset, angulated/offset, and angulated) was determined using competing risk analysis at one and seven years. Confounders were investigated with a Cox proportional-hazards model. RESULTS Median follow-up was 868 days (interquartile range 418 to 1,364). The offset liner design reduced the risk of revision (hazard ratio (HR) 0.68 (95% confidence interval (CI) 0.50 to 0.92)), while the angulated/offset liner increased the risk of revision for mechanical failure (HR 1.81 (95% CI 1.38 to 2.36)). The cumulative incidence of revision was lowest for the offset liner at one and seven years (1.0% (95% CI 0.7 to 1.3) and 1.8% (95% CI 1.0 to 3.0)). No difference was found between standard, lipped, and angulated liner designs. Higher age at index primary THA and an Elixhauser Comorbidity Index greater than 0 increased the revision risk in the first year after surgery. Implantation of a higher proportion of a single design of liner in a hospital reduced revision risk slightly but significantly (p = 0.001). CONCLUSION The use of standard acetabular component liners remains a good choice in primary uncemented THA, as most modified liner designs were not associated with a reduced risk of revision for mechanical failure. Offset liner designs were found to be beneficial and angulated/offset liner designs were associated with higher risks of revision. Cite this article: Bone Joint J 2022;104-B(7):801-810.

中文翻译:

改良的髋臼组件衬垫设计在降低翻修风险方面并不优于标准衬垫:来自德国关节成形术登记处的 151,096 例非骨水泥全髋关节置换术的分析。

AIMS Registry 对改良髋臼聚乙烯 (PE) 衬垫设计的研究有限。我们调查了标准和改良 PE 髋臼衬垫设计对初次非骨水泥全髋关节置换术 (THA) 机械并发症翻修率的影响。方法 我们分析了 2012 年 11 月至 2020 年 11 月期间来自德国关节成形术登记处 (EPRD) 的 151,096 例原发性非骨水泥 THA。确定了标准和四种改良 PE 内衬(唇形、偏移、成角/偏移和成角)的机械并发症翻修的累积发生率在一年和七年使用竞争风险分析。使用 Cox 比例风险模型研究混杂因素。结果 中位随访时间为 868 天(四分位距为 418 至 1,364)。偏移衬里设计降低了翻修的风险(风险比 (HR) 0。68(95% 置信区间 (CI) 0.50 至 0.92)),而有角度/偏移的衬垫增加了机械故障翻修的风险(HR 1.81(95% CI 1.38 至 2.36))。1 年和 7 年偏移衬里的累积翻修发生率最低(1.0%(95% CI 0.7 至 1.3)和 1.8%(95% CI 1.0 至 3.0))。标准、唇形和角形衬里设计之间没有发现差异。初次 THA 的较高年龄和大于 0 的 Elixhauser 合并症指数增加了术后第一年的翻修风险。在医院植入较高比例的单一设计衬垫可略微但显着降低翻修风险(p = 0.001)。结论 使用标准髋臼假体衬垫仍然是原发性非骨水泥 THA 的良好选择,因为大多数改进的衬垫设计与降低机械故障修正风险无关。偏移衬里设计被发现是有益的,并且倾斜/偏移衬里设计与更高的翻修风险相关。引用这篇文章:骨关节 J 2022;104-B(7):801-810。
更新日期:2022-07-01
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