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Title: [Mid- and long-term effectiveness and failure causes analysis of large-head metal-on-metal total hip arthroplasty].
Author: Li J, Zhou K, Chen Z, Wang D, Zhou Z, Kang P, Shen B, Yang J, Pei F.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Feb 15; 31(2):144-149. PubMed ID: 29786243.
Abstract:
OBJECTIVE: To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty (large-head MoM THA). METHODS: Between March 2007 and May 2010, 159 patients (183 hips) underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females (54 hips) and 109 males (129 hips) with an average age of 50 years (range, 20-78 years). Single hip was involved in 135 cases (left hip in 69 cases and right hip in 66 cases) and double hips in 24 cases. The causes included femoral head necrosis in 74 cases (93 hips), Legg-Calve-Perthes in 1 case (1 hip), osteoarthritis in 18 cases (19 hips), developmental dysplasia of the hip in 17 cases (18 hips), osteoarthritis after hip septic infection in 8 cases (8 hips), traumatic arthritis of the hip in 6 cases (6 hips), femoral neck fracture in 17 cases (17 hips), ankylosing spondylitis in 8 cases (11 hips), rheumatoid arthritis of hip in 9 cases (9 hips), and adult onset Still's disease in 1 case (1 hip). Before operation, visual analogue scale (VAS) was 6.59±0.87; Harris score was 45.99±8.07. RESULTS: Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years (mean, 6.1 years). Implant failure was observed in 15 cases (17 hips), and the 5-year survival rate of large-head MoM THA was 91.80% (168/183). The causes of implant failure after THA were inflammatory pseudotumor in 4 cases (4 hips), acetabular aseptic loosening in 3 cases (3 hips), osteolysis in 4 cases (5 hips), acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases (3 hips), and functional disused in 1 case (2 hips). Of them, 9 cases (11 hips) did not receive revision surgery for various reasons, while 6 cases (6 hips) underwent revision surgery at 1.2-5.4 years (mean 3.7 years) after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81.37±10.75 respectively, showing significant differences when compared with preoperative scores ( t=-35.547， P=0.000； t=33.823， P=0.000). The function was excellent in 44 hips, good in 89 hips, fair in 33 hips, and poor in 17 hips. CONCLUSION: Large-head MoM THA has a high revision rate during mid- and long-term follow-up because of inflammatory pseudotumor, acetabular aseptic loosening, and osteolysis. Early revision can effectively improve the function of the hip and improve patients'quality of life. 目的: 总结大直径股骨头金属对金属（以下简称大头金对金）人工全髋关节置换术（total hip arthroplasty，THA）后中远期疗效，分析置换失败原因。. 方法: 回顾分析 2007 年 3 月—2010 年 5 月采用大头金对金 THA 治疗的 159 例（183 髋）患者临床资料。男 109 例（129 髋），女 50 例（54 髋）；年龄 20～78 岁，平均 50 岁。单髋 135 例，其中左髋 69 例、右髋 66 例；双髋 24 例。初次置换原因：股骨头缺血性坏死 74 例（93 髋），Perthes 病 1 例（1 髋），髋关节原发性骨关节炎 18 例（19 髋），髋关节发育不良继发骨关节炎 17 例（18 髋），化脓性髋关节炎治愈后骨关节炎 8 例（8 髋），髋关节创伤性关节炎 6 例（6 髋），股骨颈骨折 17 例（17 髋），强制性脊柱炎髋关节受累 8 例（11 髋），髋关节类风湿性关节炎 9 例（9 髋），成人 Still 病 1 例（1 髋）。术前 Harris 评分（45.99±8.07）分，疼痛视觉模拟评分（VAS）为（6.59±0.87）分。. 结果: 术后患者切口均Ⅰ期愈合，无手术相关并发症发生。患者均获随访，随访时间 1.2～8.2 年，平均 6.1 年。术后 15 例（17 髋）失败，假体 5 年生存率为 91.80%（168/183）。失败原因：炎性假瘤形成 4 例（4 髋），髋臼松动 3 例（3 髋），骨溶解 4 例（5 髋），髋臼松动并炎性假瘤形成 3 例（3 髋），功能失用性表现 1 例（2 髋）。其中 9 例（11 髋）因多种原因未行翻修术；6 例（6 髋）于初次置换术后 1.2～5.4 年，平均 3.7 年行翻修术。末次随访时，VAS 评分为（1.72±1.48）分，髋关节 Harris 评分为（81.37±10.75）分，与术前比较差异均有统计学意义（ t=–35.547， P=0.000； t=33.823， P=0.000）；其中 44 髋为优，89 髋为良，33 髋为可，17 髋为差。. 结论: 大头金对金 THA 术后中远期失败率较高，失败原因主要为炎性假瘤形成、髋臼松动和骨溶解。尽快实施翻修手术可有效改善患者功能障碍，提高生活质量。.

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