What’s New in Hip Replacement

摘要

About 19% of patients with degenerative joint disease awaiting a total hip arthroplasty (THA) experience a health state worse than death. Pain is the main contributing factor1. Reducing the burden of completing complicated patient-reported outcome measures (PROMs) remains a challenge. A possible alternative is the use of a modified Single Assessment Numerical Evaluation (M-SANE). This 1-question PROM was shown to perform similarly to multiple-question PROMs among patients undergoing primary THA2. Implant Design and Related Outcomes Cemented Compared with Cementless Stem Fixation In a recent study on 1,671 Medicare patients undergoing primary THAs during a 4-year span (2014 to 2017), cemented femoral fixation outperformed cementless fixation, with a significantly higher likelihood of discharge home and a trend toward a shorter length of stay and lower readmission rate, cost of care, and reoperation rate3. A Norwegian Arthroplasty Register study based on 66,995 THAs from 2005 to 2017 also found the highest risk of revision in elderly women (≥55 years of age) receiving cementless stems, mainly due to periprosthetic fracture and dislocation4. Highly Cross-Linked Polyethylene (HXLPE) A long-term follow-up (mean, 16 years) of a prospectively collected cohort of 237 patients <50 years of age demonstrated significantly less wear-related revision and higher survivorship in the HXLPE group compared with the non-HXLPE group5. The evidence from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) revision data set indicated that the best survival at a 12-year follow-up was observed in THAs utilizing polyethylene liners subjected to a total radiation dose between ≥5 Mrad and <10 Mrad, followed by remelting, and incorporating an asymmetrical face. An irradiation dose of ≥10 Mrad showed no further risk reduction6. Ceramic-on-Ceramic or Ceramic-on-Polyethylene Design Two long-term follow-up studies (minimum, 15 years) on a ceramic-on-ceramic design and/or ceramic-on-polyethylene design demonstrated no sign of osteolysis based on radiographic or computed tomographic (CT) imaging7,8. The baseline ceramic fracture rate in the contemporary ceramic-on-ceramic design was also investigated. In a Level-I meta-analysis study, Yoon et al. reported a lower rate of ceramic fracture in the delta group (0.2%) compared with the forte group (0.5%). Also, the ceramic fracture rate per 1,000 patient-years was 0.5 for the delta group and 0.9 for the forte group. The ceramic head fracture rate was 0.1% for the delta group compared with 0.2% for the forte group9. Dual-Mobility Construct A Level-III propensity score matching study from the Nordic Arthroplasty Register Association (NARA) demonstrated that the use of a dual-mobility construct as primary treatment for hip fracture (4,520 hip fractures) was associated with an overall lower risk of revision, especially due to dislocation10. The conclusion of the study ought to be interpreted with caution, as a majority of the THAs were performed via a posterolateral approach and there was an overall higher mortality rate with a dual-mobility construct (40.1%) than with a conventional cup (26.6%)10,11. In another study, 100% survivorship at 10 to 16 years was reported, using a contemporary dual-mobility construct design with hydroxyapatite coating. No dislocations, revisions, or osteolysis were observed. However, there was a very high number of patients lost to follow-up (167 of 310 died before 10 years)12. Reduced rates of dislocation were also found in a dual-mobility construct compared with a conventional bearing in a retrospective case-control study among 267 revision THA cases done via anterior and lateral approaches at an intermediate-term follow-up (24 to 73 months)13. Patient Factors in Relation to Outcomes Not all patients recover at the same rate. A Level-III prognostic study from the Dutch joint registry (6,030 patients) identified 3 subgroups of patients with different f