Comparação da taxa de desgaste entre componentes de cerâmica sobre cerâmica, de metal sobre polietileno de alta ligação cruzada e de metal sobre metal^[∗]

Resumo

Objetivo Hoje, não há evidências sobre o acompanhamento em médio prazo da artroplastia total do quadril (ATQ) não cimentada com componentes de polietileno de alta ligação cruzada (highly cross-linked) sobre metal (MoP, na sigla em inglês), de cerâmica sobre cerâmica (CoC, na sigla em inglês), e de metal sobre metal (MoM, na sigla em inglês). Nosso objetivo foi calcular a taxa de desgaste entre 5 a 10 anos e a taxa de incidência de osteólise nos 3 tipos de componentes.

Métodos Um total de 77 pacientes foram submetidos a ATQ com componentes de MoP; 105 foram submetidos ao mesmo procedimento com componentes de CoC, e 55 foram submetidos à ATQ com componentes de MoM. A média de idade dos pacientes no momento da cirurgia foi de 64,7, 55,9 e 59,9 anos nos grupos de componentes MoP, de CoC, e de MoM, respectivamente. As medidas clínicas e radiológicas em um período médio de acompanhamento de 7,6 anos foram analisadas.

Resultados As pontuações médias de Harris no período pós-operatório não mostraram diferença entre os grupos. As taxas médias anuais de desgaste do revestimento foram de 0,0160, 0,0040 e 0,0054 mm/ano em componentes de MoP, de CoC, e de MoP, respectivamente; a taxa de desgaste dos componentes de CoC foi significativamente menor do que as dos demais. A osteólise (14,5%) nos componentes de MoM foi significativamente mais frequente em comparação aos demais. A sobrevida de Kaplan-Meier aos 10 anos com afrouxamento do implante ou revisão da ATQ como desfecho foi de 96,1% (intervalo de confiança [IC] de 95%: 88,4–98,7) nos componentes de MoP, de 98,6% (IC95%: 90,3–98,6) nos componentes de CoC, e de 98,2% (IC95%: 88,0–99,7) nos componentes de MoM (p = 0,360).

Conclusão Os resultados clínicos e radiológicos de componentes de MoP e de CoC foram excelentes.

Palavras-chave

artroplastia - cerâmicas - metais - polietilenos - desenho de próteses

^∗ Estudo conduzido no Departamento de Cirurgia Ortopédica, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku Nagoya, Japão.

• Referências

• 1 D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res 2012; 470 (02) 373-381
• 2 Shetty V, Shitole B, Shetty G, Thakur H, Bhandari M. Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis. Int Orthop 2011; 35 (09) 1281-1287
• 3 Callary SA, Solomon LB, Holubowycz OT, Campbell DG, Munn Z, Howie DW. Wear of highly crosslinked polyethylene acetabular components. Acta Orthop 2015; 86 (02) 159-168
• 4 D'Antonio J, Capello W, Manley M, Bierbaum B. New experience with alumina-on-alumina ceramic bearings for total hip arthroplasty. J Arthroplasty 2002; 17 (04) 390-397
• 5 Engh Jr CA, Stepniewski AS, Ginn SD, Beykirch SE, Sychterz-Terefenko CJ, Hopper RH. , et al. A randomized prospective evaluation of outcomes after total hip arthroplasty using cross-linked marathon and non-cross-linked Enduron polyethylene liners. J Arthroplasty 2006; 21 (06) (Suppl. 02) 17-25
• 6 Nikolaou VS, Edwards MR, Bogoch E, Schemitsch EH, Waddell JP. A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. J Bone Joint Surg Br 2012; 94 (04) 459-465
• 7 Takao M, Ohzono K, Nishii T, Miki H, Nakamura N, Sugano N. Cementless modular total hip arthroplasty with subtrochanteric shortening osteotomy for hips with developmental dysplasia. J Bone Joint Surg Am 2011; 93 (06) 548-555
• 8 Milošev I, Kovač S, Trebše R, Levašič V, Pišot V. Comparison of ten-year survivorship of hip prostheses with use of conventional polyethylene, metal-on-metal, or ceramic-on-ceramic bearings. J Bone Joint Surg Am 2012; 94 (19) 1756-1763
• 9 Wyles CC, Jimenez-Almonte JH, Murad MH, Norambuena-Morales GA, Cabanela ME, Sierra RJ. , et al. There Are No Differences in Short- to Mid-term Survivorship Among Total Hip-bearing Surface Options: A Network Meta-analysis. Clin Orthop Relat Res 2015; 473 (06) 2031-2041
• 10 Bascarevic Z, Vukasinovic Z, Slavkovic N, Dulic B, Trajkovic G, Bascarevic V. , et al. Alumina-on-alumina ceramic versus metal-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a comparative study. Int Orthop 2010; 34 (08) 1129-1135
• 11 Higuchi Y, Hasegawa Y, Seki T, Komatsu D, Ishiguro N. Significantly Lower Wear of Ceramic-on-Ceramic Bearings Than Metal-on-Highly Cross-Linked Polyethylene Bearings: A 10- to 14-Year Follow-Up Study. J Arthroplasty 2016; 31 (06) 1246-1250
• 12 Kanoh T, Hasegawa Y, Masui T, Yamaguchi J, Kawabe K, Ishiguro N. Accurate acetabular component orientation after total hip arthroplasty using an acetabular alignment guide. J Arthroplasty 2010; 25 (01) 81-86
• 13 Mestriner MB, Verquietini CM, Waisberg G, Akkari M, Fukunaga ET, Santili C. Radiographic evaluation in epiphysiolysis: possible predictors of bilaterality?. Acta Ortop Bras 2012; 20 (04) 203-206
• 14 Kim YH, Kim JS, Oh SH, Kim JM. Comparison of porous-coated titanium femoral stems with and without hydroxyapatite coating. J Bone Joint Surg Am 2003; 85-A [phone]
• 15 Sutherland CJ, Wilde AH, Borden LS, Marks KE. A ten-year follow-up of one hundred consecutive Müller curved-stem total hip-replacement arthroplasties. J Bone Joint Surg Am 1982; 64 (07) 970-982
• 16 Lee JH, Lee BW, Lee BJ, Kim SY. Midterm results of primary total hip arthroplasty using highly cross-linked polyethylene: minimum 7-year follow-up study. J Arthroplasty 2011; 26 (07) 1014-1019
• 17 Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60 (02) 217-220
• 18 Barrack RL, Lavernia C, Szuszczewicz ES, Sawhney J. Radiographic wear measurements in a cementless metal-backed modular cobalt-chromium acetabular component. J Arthroplasty 2001; 16 (07) 820-828
• 19 García-Rey E, García-Cimbrelo E, Cruz-Pardos A, Ortega-Chamarro J. New polyethylenes in total hip replacement: a prospective, comparative clinical study of two types of liner. J Bone Joint Surg Br 2008; 90 (02) 149-153
• 20 Brooker AF, Bowerman JW, Robinson RA, Riley Jr LH. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973; 55 (08) 1629-1632
• 21 Cai P, Hu Y, Xie J. Large-diameter Delta ceramic-on-ceramic versus common-sized ceramic-on-polyethylene bearings in THA. Orthopedics 2012; 35 (09) e1307-e1313
• 22 Gallo J, Goodman SB, Lostak J, Janout M. Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 156 (03) 204-212
• 23 Lombardi Jr AV, Mallory TH, Cuckler JM, Williams J, Berend KR, Smith TM. Mid-term results of a polyethylene-free metal-on-metal articulation. J Arthroplasty 2004; 19 (07) (Suppl. 02) 42-47
• 24 Yin S, Zhang D, Du H, Du H, Yin Z, Qiu Y. Is there any difference in survivorship of total hip arthroplasty with different bearing surfaces? A systematic review and network meta-analysis. Int J Clin Exp Med 2015; 8 (11) 21871-21885
• 25 Greiner JJ, Callaghan JJ, Bedard NA, Liu SS, Goetz DD, Mahoney CR. Metal-on-Metal Total Hip Arthroplasty at Five to Twelve Years Follow-Up: A Concise Follow-Up of a Previous Report. J Arthroplasty 2016; 31 (08) 1773-1778
• 26 Capello WN, D'Antonio JA, Ramakrishnan R, Naughton M. Continued improved wear with an annealed highly cross-linked polyethylene. Clin Orthop Relat Res 2011; 469 (03) 825-830
• 27 Reynolds SE, Malkani AL, Ramakrishnan R, Yakkanti MR. Wear analysis of first-generation highly cross-linked polyethylene in primary total hip arthroplasty: an average 9-year follow-up. J Arthroplasty 2012; 27 (06) 1064-1068
• 28 Epinette J-A, Manley MT. No differences found in bearing related hip survivorship at 10-12 years follow-up between patients with ceramic on highly cross-linked polyethylene bearings compared to patients with ceramic on ceramic bearings. J Arthroplasty 2014; 29 (07) 1369-1372
• 29 Al-Hajjar M, Fisher J, Tipper JL, Williams S, Jennings LM. Wear of 36-mm BIOLOX(R) delta ceramic-on-ceramic bearing in total hip replacements under edge loading conditions. Proc Inst Mech Eng H 2013; 227 (05) 535-542