Sex differences in the morphological failure patterns following hip resurfacing arthroplasty

BMC Medicine

Research Article

Michael M Morlock¹  Eik Vettorazzi²  Wolfgang Rüther³  Michael Amling⁴  Jozef Zustin⁵  Andrea Hinsch⁵ 

[1] Biomechanics Section, TUHH University of Technology Hamburg-Harburg, Germany;Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany;Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Germany;Institute of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Germany;Institute of Pathology, University Medical Center Hamburg-Eppendorf, Germany;

关键词: Osteonecrosis;    Femoral Component;    Groin Pain;    Failure Pattern;    Periprosthetic Fracture;   

DOI  :  10.1186/1741-7015-9-113

 received in 2011-03-29, accepted in 2011-10-13,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundMetal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component) is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty.MethodsFemoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR) and 95% confidence intervals (CI) of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n = 133), osteonecrosis (n = 151), the presence of excessive intraosseous lymphocyte infiltration (n = 11), and interface hyperosteoidosis (n = 30). Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis.ResultsFemoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference = 0.02) and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference = 0.01). However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10.22, 95% CI 0.79, 132.57, P for difference = 0.08) and interface hyperosteoidosis (adjusted OR: 4.19, 95% CI 1.14, 15.38, P for difference = 0.03).ConclusionsWithin the limitations of this study, we demonstrated substantial sex differences in distinct failure patterns of metal-on-metal hip resurfacing. Recognition of pathogenically distinct failure modes will enable further stratification of risk factors for certain failure mechanisms and thus affect future therapeutic options for selected patient groups.

【 授权许可】

Unknown   
© Hinsch et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.