在评估社区内初级全髋关节假体的性能时,什么是最合适的比较组?

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-05-01 Epub Date: 2023-12-12 DOI:10.1177/11207000231216708
Khashayar Ghadirinejad, Stephen Graves, Richard de Steiger, Nicole Pratt, Lucian B Solomon, Mark Taylor, Reza Hashemi
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引用次数: 0

摘要

背景:髋关节置换术中使用的假体性能各不相同。其中有些假体的翻修率出乎意料地高,即异常值。澳大利亚骨科协会国家关节置换登记处(AOANJRR)已经建立了一种标准化的多阶段方法来识别这些设备。方法是将单个假体的翻修率与同类所有其他假体进行比较,但大头金属(LHMoM)假体除外。然而,随着时间的推移,假体设计和性能不断改进,因此需要重新考虑比较组。本研究旨在确定一个更具体的参照组,以更好地反映当代的手术实践:方法:根据2003年1月1日至2019年12月31日因骨关节炎(OA)进行的413,417例初次全传统髋关节置换术的数据估算了首次翻修的时间。进行了逐步排除的生存期分析。首先排除的是LHMoM,其次是其他非现代轴承表面(定义为除交联聚乙烯上的金属或陶瓷头和混合陶瓷头以外的所有轴承耦合),然后是模块化颈干设计或用于特定目的的设备(包括受限、双活动性和头的大小 结果:这些排除因素逐步降低了累计翻修率(CPR)。最终的比较对象只包括当代设计和使用的性能令人满意的假体,其 10 年 CPR 为 4.30% (95% CI, 4.2-4.41),低于 AOANJRR 目前使用的比较对象(不包括 LHMOM 的所有假体)的 4.93% (95% CI, 4.84-5.02)。在研究期间,还发现了13个使用修改后参照物的组件:结论:应该重新评估比较器械翻修率的计算方法,使其仅包括现代假体结构,以确保及早发现性能不佳的假体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
What is the most appropriate comparator group to use in assessing the performance of primary total hip prostheses within the community?

Background: There are variations in the performance of individual prostheses used in hip replacements. Some of which have unexpectedly higher revision rates - outliers. The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has established a standardised multi-stage approach for identifying these devices. This is done by comparing the revision rates of individual prostheses to all other prostheses in class, with the exception of large head metal-on-metal (LHMoM) prostheses. However, improvements in device design and performance over time have required a need to reconsider the comparator group. This study aimed to identify a more specific comparator to better reflect contemporary surgical practice.

Methods: The time to first revision was estimated on the data of 413,417 primary total conventional hip replacements undertaken for osteoarthritis (OA) from 01 January 2003 to 31 December 2019. Survivorship analyses with stepwise exclusions were undertaken. The first exclusion was LHMoM, followed by other non-modern bearing surfaces (defined as all the bearing couples except metal or ceramic heads on cross-linked polyethylene and mixed ceramic-on-ceramic), and then devices with modular neck-stem design or used for specific purposes (incl. constrained, dual-mobility, and head size <28 mm). Lastly, all remaining prostheses previously identified as having a higher than anticipated rate of revision (HTARR) were also excluded.

Results: These exclusions progressively reduced the cumulative percent revision (CPR) rate. The final comparator, which only includes satisfactory-performed prostheses of contemporary design and use, has a 10-year CPR of 4.30% (95% CI, 4.2-4.41) which is lower than 4.93% (95% CI, 4.84-5.02) for the current comparator used by the AOANJRR (all prostheses excluding LHMOM). Over the study period, 13 additional components were identified utilising the modified comparator.

Conclusions: The calculation of the comparator revision rate should be re-evaluated to include only modern prosthesis constructs to ensure that poorly performing prostheses are identified early.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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