背景:我们旨在比较不同头部大小的临床结果(28-,32-,和36毫米)在初次全髋关节置换术(THA)中平均6年随访(范围,1至17.5年)。
方法:这是我们机构(2003年至2019年)的原发性THA的回顾性连续研究。收集人口统计学和手术数据。主要结局指标是全因修正,脱位的修正,以及不包括脱位的全因翻修。连续描述性统计使用意味着,中值,范围,和95%的置信区间,在适当的地方。Kaplan-Meier存活曲线用于估计修正时间。Cox比例风险回归分析用于比较股骨头大小组之间的翻修率。手术时对年龄进行了调整,性别,初步诊断,美国麻醉医师协会评分,关节类型,和固定方法。包括10,104例原发性THA;中位年龄为69岁(范围,13至101),女性占61.5%。71.6%采用后路入路。有3,295个臀部,头部28毫米(32.6%),4,858(48.1%),具有32毫米的磁头,和1,951(19.3%),具有36毫米的头部。
结果:总翻修率为1.7%,36毫米组的翻修率最低(2.7对1.3对1.1%)。Cox回归分析显示,与28毫米相比,32和36毫米头部尺寸的全因翻修风险降低;这对于32毫米组具有统计学意义(P=0.01)。在32毫米(P=0.03)和36毫米(P=0.03)的头部尺寸中,脱位翻修的风险显着降低。不包括脱位的所有原因翻修的分析表明,头部大小之间没有显着差异。
结论:我们发现所有原因的翻修风险显著降低,但特别是对于较大头部尺寸的脱位。对无菌性松动早期修正风险增加的担忧,聚乙烯磨损,在10,104例患者的队列中,头较大的锥度腐蚀似乎没有根据,随访长达17年。
BACKGROUND: We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years).
METHODS: This was a retrospective consecutive
study of primary THA at our institution (2003 to 2019). Demographic and surgical data were collected. The primary outcome measures were all-cause revision, revision for
dislocation, and all-cause revision excluding
dislocation. Continuous descriptive statistics used means, median values, ranges, and 95% confidence intervals, where appropriate. Kaplan-Meier survival curves were used to estimate time to revision. Cox proportional hazard regression analyses were used to compare revision rates between the femoral head size groups. Adjustments were made for age at surgery, sex, primary diagnosis, American Society of Anesthesiologists score, articulation type, and fixation methods. There were 10,104 primary THAs included; median age was 69 years (range, 13 to 101) with 61.5% women. A posterior approach was performed in 71.6%. There were 3,295 hips with 28-mm heads (32.6%), 4,858 (48.1%) with 32-mm heads, and 1,951 (19.3%) with 36-mm heads.
RESULTS: Overall rate of revision was 1.7% with the lowest rate recorded for the 36-mm group (2.7 versus 1.3 versus 1.1%). Cox regression analyses showed a decreased risk of all-cause revision for 32 and 36-mm head sizes as compared to 28-mm; this was statistically significant for the 32-mm group (P = .01). Risk of revision for
dislocation was significantly reduced in both 32-mm (P = .03) and 36-mm (P = .03) head sizes. Analysis of all cause revision excluding
dislocation showed no significant differences between head sizes.
CONCLUSIONS: We found a significantly reduced risk of revision for all causes, but particularly revision for dislocation with larger head sizes. Concerns regarding increased risk of early revision for aseptic loosening, polyethylene wear, or taper corrosion with larger heads appear to be unfounded in this cohort of 10,104 patients with up to 17 years follow-up.