Long-term outcomes of small head metal-on-metal compared to ceramic-on-polyethylene primary total hip arthroplasty: a registry-based cohort study.

IF 2.6 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2025-03-01 Epub Date: 2025-02-12 DOI:10.1007/s00264-025-06437-z

Amanda I Gonzalez, Christophe Barea, Matthieu Zingg, Guido Garavaglia, Robin Peter, Pierre Hoffmeyer, Didier Hannouche, Anne Lübbeke

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Abstract

Purpose: We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup.

Methods: All primary elective MoM and CoP THAs performed 1998-2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs.

Results: Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2% (95% CI 10.6 to 16.3) in MoM and 6.3% (95% CI 4.8 to 8.3) in CoP group. Adjusted hazard ratio for all-cause revision was 1.88 (95% CI 1.34 to 2.65) comparing MoM vs. CoP. Diagnoses at revision were mainly aseptic loosening (33%) and adverse local tissue reactions (33%) in MoM and aseptic loosening in CoP group (44%). The smoothed hazard function revealed the largest difference in instantaneous revision rate between three and 14 years postoperative. After that period no difference was observed.

Conclusion: Overall, the cumulative risk of all-cause revision was almost twice as high in patients with a small head MoM as compared to a CoP THA over the 20-year period. However, most of the excess in revisions among MoM patients occurred between three and 14 years postoperative.

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小头金属对金属与陶瓷对聚乙烯初次全髋关节置换术的长期疗效比较：一项基于登记的队列研究。

目的：我们的目的是比较小头（28毫米）金属对金属（MoM）全髋关节置换术（THA）和陶瓷对聚乙烯（CoP）全髋关节置换术（使用相同的杯）的长期结果。方法：所有1998-2011年进行的主要选择性MoM和CoP tha前瞻性纳入当地注册表。患者随访至2022年12月31日。结果是全因修正、并发症和死亡率。所有tha均采用未胶结的Morscher 28 mm整体压合杯。结果：共纳入3257例THAs， 864例MoM（平均年龄63岁）和2393例CoP THAs（平均年龄72岁）。该队列的平均随访时间为12.9年（最长26.8年）。在85例MoM和79例CoP tha中进行了任何原因的翻修。MoM组20年全因修正的累积发生率为13.2% (95% CI 10.6 - 16.3)， CoP组为6.3% （95% CI 4.8 - 8.3）。与MoM和CoP相比，全因修正后的校正风险比为1.88 （95% CI 1.34 - 2.65）。翻修时的诊断主要是MoM组的无菌性松动（33%）和局部组织不良反应（33%），CoP组的无菌性松动（44%）。平滑的危险函数显示术后3年和14年瞬时翻修率的最大差异。在此之后，没有观察到任何差异。结论：总的来说，在20年的时间里，小头MoM患者的全因翻修的累积风险几乎是CoP THA患者的两倍。然而，在MoM患者中，大多数翻修量的增加发生在术后3至14年之间。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.