背景:10多年来,RMPressfit杯™已在我们部门使用。这是一个整体,弹性,采用标准聚乙烯(PE)设计的无骨水泥植入物,覆盖着薄的钛颗粒涂层。迄今为止,10多年后,没有法国研究评估这个杯子。因此,我们进行了一项回顾性研究,目的是:1)评估植入物的生存率,至少随访10年,2)评估末次随访时的功能评分,3)测量PE的磨损,4)识别放射性松动,5)寻找取杯的危险因素,6)确定需要在手术室管理的并发症。
目的:工作假设是这种植入物在10年随访时的存活率大于95%,根据国家健康与护理卓越研究所(NICE)的标准。
方法:这是一项回顾性的单中心研究,包括使用RMPressfit™(28mm摩擦大小)的全髋关节置换术(THA)治疗髋关节病(原发性或继发性)或股骨头坏死的成年患者。排除标准是随访期少于10年,放置RMPressfit™杯作为THA的次要意图(n=5)或股骨转子骨折后(n=1)。总的来说,163名患者(182髋),中位年龄(Q1-Q3)为63(56-68)岁,性别比(M/F)为1.7。使用Harris和Oxford评分评估功能评分。在术后即刻和最后一次随访中分析了放射照片。
结果:中位随访时间为10.5年(10-11.5年)。在182个臀部中,7杯被取出,对应的10年生存率为96.1%(95%CI[93.3;96.9])。在10.5岁时,哈里斯和牛津的中位数得分分别为95分(90-98分)和19分(17-23分)。分别。平均PE磨损率为0.058(0.039-0.087)mm/年。单因素分析显示男性与PE磨损相关(OR=3.6;95%CI[1.3;12.9](p=0.012))。10个杯子(6%)显示放射学不稳定性,迁移大于3毫米和/或倾斜度变化大于8°,只有9髋(6%)显示骨吸收。没有术前或围手术期因素分析与取杯相关。脱位占脱杯原因的71%(n=5)。此外,6髋经历了至少一次脱位发作,需要在手术室中通过外部操作进行复位,使系列中的整体位错率达到6%(n=11)。杯倾斜增加是假体脱位的唯一危险因素(OR=1.2;95%CI[1.09;1.4](p=0.0003))。需要手术干预的总体并发症包括15个(8.3%)植入的杯子(7个取出的杯子,6个脱位事件,需要通过手术室中的外部操作来减少,和2个臀部因早期感染而重新手术以清洗和更换移动部件)。
结论:RMPressfitcup™具有良好的长期临床和放射学结果,10年的总生存率为96.1%,并发症发生率低。在过去的2年中,RMVitamys™杯已经推出,允许使用32毫米股骨头直径的48杯,以减少脱位的风险。
方法:IV;回顾性队列。
BACKGROUND: For over 10 years, the RM Pressfit cup™ has been used in our department. This is a one-piece, elastic, cementless implant designed with standard polyethylene (PE), covered with a thin coating of titanium particles. To date, there is no French study evaluating this cup after more than 10 years. Therefore, we conducted a retrospective study in order to: 1) evaluate the survival of the implant with a minimum follow-up of 10 years, 2) evaluate the functional scores at the last follow-up, 3) measure the
wear of the PE, 4) identify radiological loosening, 5) search for risk factors for cup removal, 6) identify complications that required management in the operating theatre.
OBJECTIVE: The working hypothesis was that the survival of this implant was greater than 95% at 10 years\' follow-up, in accordance with the criteria of the National Institute for Health and Care Excellence (NICE).
METHODS: This was a retrospective monocentric study, including adult patients who underwent total hip arthroplasty (THA) with an RM Pressfit cup™ (28 mm friction size) for coxarthrosis (primary or secondary) or femoral head osteonecrosis. Exclusion criteria were a follow-up period of less than 10 years, the placement of an RM Pressfit cup™ as a secondary intention for a THA (n = 5) or following a trochanteric fracture (n = 1). In total, 163 patients (182 hips) with a median age (Q1-Q3) of 63 (56-68) years, and a sex ratio (M/F) of 1.7 were included. Functional scores were evaluated using the Harris and Oxford scores. Radiographs were analyzed in the immediate postoperative period and at the last follow-up.
RESULTS: The median follow-up was 10.5 (10-11.5) years. Of the 182 included hips, 7 cups were removed, corresponding to a 10-year survival rate of 96.1% (95% CI [93.3; 96.9]). The median Harris and Oxford scores at 10.5 years were 95 (90-98) and 19 (17-23) points, respectively. The median PE
wear rate was 0.058 (0.039-0.087) mm/year. Univariate analysis showed that male gender was associated with PE
wear (OR = 3.6; 95% CI [1.3; 12.9] (p = 0.012)). Ten cups (6%) showed radiological instability with migration greater than 3 mm and/or variation in inclination greater than 8 °, and only 9 hips (6%) showed bone resorption. No preoperative or perioperative factors analyzed were associated with cup removal. Dislocation accounted for 71% (n = 5) of the causes of cup removal. Additionally, 6 hips experienced at least one dislocation episode requiring reduction by external maneuvers in the operating room, bringing the overall dislocation rate in the series to 6% (n = 11). Increased cup inclination was the only risk factor for prosthetic dislocation (OR = 1.2; 95% CI [1.09; 1.4] (p = 0.0003)). Overall complications requiring surgical intervention included 15 (8.3%) implanted cups (7 removed cups, 6 dislocation episodes requiring reduction by external maneuvers in the operating room, and 2 hips reoperated for washing and changing of mobile components due to early infection).
CONCLUSIONS: The RM Pressfit cup™ gives good long-term clinical and radiological results with an overall survival of 96.1% and a low complication rate over 10 years. Over the last 2 years the RM Vitamys™ cup has been introduced allowing the use of 32 mm femoral head diameter for size 48 cups, to reduce the risk of dislocation.
METHODS: IV; retrospective cohort.