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首页> 美国卫生研究院文献>Clinical Orthopaedics and Related Research >The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial
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The John Charnley Award: Metal-on-Metal Hip Resurfacing versus Large-diameter Head Metal-on-Metal Total Hip Arthroplasty: A Randomized Clinical Trial

机译：约翰·查恩利奖：金属髋关节置换与大直径头部金属髋关节置换术：一项随机临床试验

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AbstractResurfacing arthroplasty has become an attractive option for young patients who want to maintain a high activity level. One recent study reported modestly increased activity levels for patients with resurfacing compared to standard total hip arthroplasty (THA). We conducted a prospective randomized clinical trial to compare clinical outcomes of resurfacing versus large-head metal-on-metal total hip arthroplasty. We randomized 107 patients deemed eligible for resurfacing arthroplasty to have either resurfacing or standard THA. Patients were assessed for quality-of-life outcomes using the PAT-5D index, WOMAC, SF-36, and UCLA activity score. The minimum followup was 0.8 years (mean, 1.1 years; range, 0.8–2.2 years). Of the 73 patients followed at least one year, both groups reported improvement in quality of life on all outcome measures. There was no difference in quality of life between the two arms in the study. Serum levels of cobalt and chromium were measured in a subset of 30 patients. In both groups cobalt and chromium was elevated compared to baseline. Patients receiving a large-head metal-on-metal total hip had elevated ion levels compared to the resurfacing arm of the study. At 1 year, the median serum cobalt increased 46-fold from baseline in patients in the large-head total hip group, while the median serum chromium increased 10-fold. At 1 year, serum cobalt was 10-fold higher and serum chromium 2.6-fold higher than in the resurfacing arm. Due to these excessively high metal ion levels, the authors recommend against further use of this particular large-head total hip arthroplasty.>Level of Evidence: Level I, randomized clinical trial. See Guidelines for Authors for a complete description of levels of evidence.
机译：摘要关节置换术已成为希望保持高活动水平的年轻患者的一种有吸引力的选择。一项最新的研究报道，与标准的全髋关节置换术（THA）相比，换肤患者的活动水平有所提高。我们进行了一项前瞻性随机临床试验，以比较表面置换术与大头金属对金属全髋关节置换术的临床效果。我们将107例适合进行表面置换术的患者随机分为表面置换术或标准THA患者。使用PAT-5D指数，WOMAC，SF-36和UCLA活动评分评估患者的生活质量。最小随访时间为0.8年（平均1.1年;范围0.8-2.2年）。在至少随访一年的73例患者中，两组均报告了所有结果指标均改善了生活质量。在研究中，两组之间的生活质量没有差异。在30名患者的亚组中测量了血清中钴和铬的水平。两组中的钴和铬均高于基线。与研究中的重铺手臂相比，接受大头金属对全髋关节置换的患者离子水平升高。在1年时，大头全髋关节置换患者的血清钴中位数比基线增加了46倍，而血清铬中位数增加了10倍。在1年时，血清钴比重铺手臂高10倍，血清铬高2.6倍。由于这些金属离子水平过高，作者建议不要进一步使用这种特殊的大头全髋关节置换术。>证据水平： I级，随机临床试验。有关证据水平的完整说明，请参见《作者指南》。

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