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Rocco P. Pitto Mikaela Garland Laurent Sedel 《Clinical orthopaedics and related research》2015,473(12):3790-3795
Background
Dislocation is a major complication after primary total hip arthroplasty (THA), but little is known about the potential relationships between bearing materials and risk of dislocation. Dislocation within the first year after surgery is typically related to either surgical error or patient inattention to precautions, but the reasons for dislocation after the first year are often unclear, and whether ceramic bearings are associated with an increased or decreased likelihood of late dislocation is controversial.Questions/purposes
The purpose of this study was to use a national registry to assess whether the choice of bearings–metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), or metal-on-metal (MoM)–is associated with differences in the risk of late dislocation.Methods
Data from primary THAs were extracted from the New Zealand Joint Registry over a 10-year period. The mean age of patients was 69 years (SD ± 12 years), and 53% were women. The median followup in this population was 7 years (range, 1–13 years). The surgical approach used was posterior in 66% of THAs, lateral in 29%, and anterior in 5%. The primary endpoint was late revision for dislocation with “late” defined as greater than 1 year postoperatively. A total of 73,386 hips were available for analysis: 65% MoP, 17% CoP, 10% CoC, and 7% MoM. In general, patients receiving CoC and MoM bearings were younger compared with patients receiving CoP and MoP bearings.Results
Four percent of the hips were revised (3130 THAs); 867 THAs were revised for dislocation. Four hundred seventy THAs were revised for dislocation after the first postoperative year. After adjusting for head size, age, and surgical approach, only CoP (hazard ratio [HR], 2.10; p = 0.021) demonstrated a higher proportion of revision, whereas MoP did not (HR, 1.76; 95% p = 0.075). There were no differences of revisions for dislocation in the CoC (HR, 1.60; p = 0.092) and MoM cohorts (HR, 1.54; p = 0.081).Conclusions
Dislocation is a common reason for revision after THA. The relationships between bearing materials and risk of revision for late dislocation remain controversial. This large registry study demonstrated that bearing surface had little association with the incidence of late dislocation. Future studies with longer followups should continue to investigate this question.Level of Evidence
Level III, therapeutic study. 相似文献4.
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Kirill Gromov Alma B. Pedersen S?ren Overgaard Peter Gebuhr Henrik Malchau Anders Troelsen 《Clinical orthopaedics and related research》2015,473(11):3391-3398
Background
Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world’s registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented.Questions/purposes
The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA; and (4) the time to first revision of primary THA between primary cementless and cemented femoral components.Methods
Primary THAs with cemented (n = 1791) and uncemented (n = 805) femoral components that subsequently sustained first revision of the femoral component were identified from the Danish Hip Arthroplasty Registry (DHR). As of 2012, 120,988 primary THAs and 19,282 revisions were registered in the DHR with completeness of 97% and 90% for primary and revision THA, respectively. Median followup for revisions of primary THA with cemented and cementless femoral component was 4 years (range, 0–17 years) and 2 years (range, 0–16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient- and surgery-related data are collected from Danish medical databases. Recording of bone defects in the DHR is based on surgeons’ intraoperative findings.Results
With the numbers studied, we found no differences in the risk of second revision between the overall cohort between cementless and cemented techniques (HR, 1.32; 95% CI, 0.97–1.80; p = 0.076); however, a second revision for any reason was more likely in patients < 70 years old in whom the index arthroplasty was performed using a cementless technique (HR, 1.48; 95% CI, 1.01–2.17; p = 0.046). Increasingly severe femoral bone defects of type II (30% [532 of 1791] versus 13% [104 of 805]; p < 0.001) type III (11% [200 of 1791] versus 2% [12 of 805]; p < 0.001) and type IV (1% [26 of 1791] versus 0.4% [three of 805]; p = 0.016) were more frequent at revisions of cemented femoral components compared with cementless femoral components. Indications for first revision differed between primary cemented and uncemented femoral components, because a larger proportion of cemented femoral components was revised as a result of aseptic loosening compared with cementless femoral components (74% [1329 of 1791] versus 25% [197 of 805]; p < 0.001), whereas a larger proportion of cementless femoral components was revised as a result of a fracture compared with cemented femoral components (46% [371 of 805] versus 10% [168 of 1791]; p < 0.001). Failure before 5 years was more likely in cementless femoral components than cemented femoral components (91% [733 of 805] versus 44% [749 of 1791], p < 0.001).Conclusions
We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients < 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cementless fixation in primary THA may lead to inferior survivorship of first revision THA.Level of Evidence
Level III, therapeutic study. 相似文献6.
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Martijn A. J. te Stroet Wim H. C. Rijnen Jean W. M. Gardeniers Albert van Kampen B. Willem Schreurs 《Clinical orthopaedics and related research》2015,473(12):3867-3875
Background
The increasing number of total hip arthroplasties (THAs) performed in younger patients will inevitably generate larger numbers of revision procedures for this specific group of patients. Unfortunately, no satisfying revision method with acceptable survivorship 10 years after revision has been described for these patients so far.Questions/purposes
The purposes of this study were to (1) analyze the clinical outcome; (2) complication rate; (3) survivorship; and (4) radiographic outcome of cemented revision THA performed with impaction bone grafting (IBG) on both the acetabular and femoral sides in one surgery in patients younger than 55 years old.Methods
During the period 1991 to 2007, 86 complete THA revisions were performed at our institution in patients younger than 55 years. In 34 of these 86 revisions (40%), IBG was used on both the acetabular and femoral sides in 33 patients. Mean patient age at revision surgery was 46.4 years (SD 7.6). No patient was lost to followup, but three patients died during followup. None of the deaths were related to the revision surgery. The mean followup for the surviving hips was 11.7 years (SD 4.6). We also analyzed complication rate.Results
The mean Harris hip score improved from 55 (SD 18) preoperatively to 80 points (SD 16) at latest followup (p = 0.009). Six hips underwent a rerevision (18%): in four patients, both components were rerevised; and in two hips, only the cup was revised. Patient 10-year survival rate with the endpoint of rerevision for any component for any reason was 87% (95% confidence interval [CI], 67%–95%) and with the endpoint of rerevision for aseptic loosening, the survival rate was 97% (95% CI, 80%–100%). In total six cups were considered radiographically loose, of which four were rerevised. Three stems were radiographically loose, of which none was rerevised.Conclusions
IBG is a valuable biological revision technique that may restore bone stock in younger patients. Bone stock reconstruction is important, because these patients likely will outlive their revision implants. Bone reconstruction with impaction grafting may facilitate future revisions.Level of Evidence
Level IV, therapeutic study. 相似文献9.
Yona Kosashvili Michael Drexler David Backstein Oleg Safir Dror Lakstein Alex Safir Raja Chakravertty Tim Dwyer Allan Gross 《Canadian journal of surgery》2014,57(2):E15-E18
Background
Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation between the components revised during hip arthroplasty (femur only, acetabulum only and both components) to the rates of dislocation in the first and multiple revision THA.Methods
We obtained data from consecutive revision THAs performed between January 1982 and December 2005. Patients were grouped into femur-only revision, acetabulum-only revision and revision THA for both components.Results
A total of 749 revision THAs performed during the study period met our inclusion criteria: 369 first-time revisions and 380 repeated revisions. Dislocation rates in patients undergoing first-time revisions (5.69%) were significantly lower than in those undergoing repeated revisions (10.47%; p = 0.022). Within the group of first-time revisions, dislocation rates for acetabulum-only revisions (10.28%) were significantly higher than those for both components (4.61%) and femur-only (0%) reconstructions (p = 0.025).Conclusion
Although patients undergoing first-time revisions had lower rates of dislocations than those undergoing repeated revisions, acetabulum-only reconstructions performed at first-time revision arthroplasty entailed an increased risk for instability. 相似文献10.
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Young-Hoo Kim Jang-Won Park Jun-Shik Kim Devarshi Rastogi 《Clinical orthopaedics and related research》2015,473(9):2990-3000
Background
Numerous studies have investigated the clinical and radiographic results of revision THAs with use of cementless stems and cortical strut allografts. However, to our knowledge, no long-term followup studies have evaluated patients undergoing revision THA with use of cortical strut allografts where the allografts provided the primary stability for extensively coated femoral stems in the presence of extensive femoral diaphyseal bone defects.Question/purposes
We performed this study to determine (1) validated outcomes scores; (2) radiographic signs of fixation and allograft healing; (3) frequency of complications; and (4) survivorship of the components after use of cortical strut onlay allografts in Types IIIB and IV femoral diaphyseal bone defects.Methods
Between 1994 and 2003, we performed 140 revision THAs in 130 patients with Paprosky Types IIIB and IV femoral diaphyseal defects. The patients were treated using extensively coated femoral stems and cortical strut allografts because primary axial or rotational stability could not be achieved without grafting. Ten of the patients (10 hips; 7.7%) were lost to followup or died before 10 years; the remaining 120 patients (130 hips) represent the study group in this retrospective study. There were 66 men and 54 women. Their mean age at the time of index surgery was 59 ± 18 years (range, 36–67 years). The primary diagnosis was predominantly osteonecrosis of the femoral head (53%). The most common reason for revision was aseptic loosening (97%), followed by periprosthetic fracture (3%). The mean time from primary to revision THA was 12 years (range, 8–27 years). The mean duration of followup was 16.1 years (range, 12–20 years).Results
The mean Harris hip score was 39 ± 10 points before revision and improved to 86 ± 14 points at 16 years followup (p = 0.02). The mean preoperative WOMAC score was 62 ± 29 (41–91) points and improved to 22 ± 19 (11–51) points at 16 years followup (p = 0.003). Of the 130 stems, 113 (87%) had bone ingrowth, five (4%) had stable fibrous ingrowth, and 12 (9%) were unstable. All allografts were incorporated. Four hips (3%) had a displaced femoral shaft fracture at the stem tip; four (3%) had a postoperative dislocation; and six (5%) had early postoperative infection. Kaplan-Meier survivorship analysis, with revision or radiographic failure as the endpoint, revealed that the 16-year rate of survival of the components was 91% (95% CI, 0.88%–0.96%).Conclusion
Supportive cortical strut onlay allografts provided high survivorship beyond 12 years of followup in revision THAs. Future studies might compare this approach with allograft-prosthesis composites, proximal femoral replacement, or modular fluted, tapered stems.Level of Evidence
Level IV, therapeutic study. 相似文献12.
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Olli Lainiala Aleksi Reito Petra Elo Jorma Pajam?ki Timo Puolakka Antti Eskelinen 《Clinical orthopaedics and related research》2015,473(7):2305-2313
Background
High revision rates attributable to adverse reactions to metal debris have been reported for total hip arthroplasties (THAs) with metal-on-metal implants and hip resurfacings. The effect of revision on blood metal ion levels is described only in small series, the clinical results of revisions have been contradictory, and concerns regarding component loosening have been presented.Questions/purposes
We asked: (1) Did revision surgery result in a reduction to normal for whole blood cobalt (Co) and chromium (Cr) levels (2) What changes to the Oxford Hip Score were observed after revision of these hips with metal-on-metal implants? (3) Were there radiologic signs of component loosening observed on 1-year followup radiographs?Methods
Between September 2010 and April 2013, 154 patients (166 hips) who had THAs with implantation of the Articular Surface Replacement (ASR™) system and 44 patients (49 hips) who had hip resurfacings of the ASR™ implant underwent revision surgery for adverse reactions to metal debris at our institution, after recall of these components in August 2010. General indications for revision of these implants included a symptomatic hip and/or a predominantly solid pseudotumor seen on cross-sectional imaging. Since recall, patients were systematically followed after revision with Oxford Hip Score questionnaires, blood Co and Cr measurements (analyzed from whole blood with dynamic reaction-cell inductively coupled plasma-mass spectrometry), and plain radiographs at 2 and 12 months after revision surgery, and thereafter at 2-year intervals. Preoperative and 1-year postoperative blood Co and Cr values were available for 93% (185 of 198 patients), Oxford Hip Score for 76% (151 of 198 patients), and plain radiographs for all patients.Results
Whole-blood levels of Co decreased below the 7 ppb cut-off value in all patients with revision of unilateral THA or resurfacing, however, blood Cr levels remained elevated in four of 90 patients (4%) in the unilateral THA group and four of 34 patients (12%) in the unilateral resurfacing group. All had ultrahigh (> 40 ppb) preoperative Cr levels. Cr levels remained elevated in six of the patients at the 3-year followup. The median Oxford Hip Score improved from preoperative to 1-year postoperative in the unilateral THA group (38 [4–48] to 40 [9–48], p = 0.049) and in the unilateral hip resurfacing group (37.5 [9–48] to 44 [13–48], p = 0.011). No improvement was seen in patients who had bilateral THAs (37 [14–48] to 41 [9–48], p = 0.196). Only minor radiographic abnormalities were seen, with no suspicion of component loosening.Conclusions
Metal-on-metal THAs and resurfacings have raised concerns and an emerging rate of revisions has been seen for many different metal-on-metal hip prostheses worldwide. Revision surgery seems to be effective for removal of the systemic metal ion burden, even though blood Cr remained elevated in a few patients for more than 3 years after removal of the metal-on-metal implant. In patients with bilateral metal-on-metal hip replacements the remaining metal-on-metal implant still supplies the body with Co and Cr ions after a unilateral revision, and therefore followup should be continued. Adverse reactions to metal debris do not seem to compromise implant ingrowth after revision surgery. However, as some of our patients still had a poor functional outcome at 12 months after revision surgery, additional research is warranted to determine the optimal time for patients to undergo revision surgery for suspected adverse reactions to metal debris.Level of Evidence
Level IV, therapeutic study. 相似文献15.
Jeffrey J. Cherian Julio J. Jauregui Samik Banerjee Todd Pierce Michael A. Mont 《Clinical orthopaedics and related research》2015,473(8):2700-2709
Background
Aseptic loosening is the most common cause for revisions after lower-extremity total joint arthroplasties, however studies differ regarding the degree to which host factors influence loosening.Questions/purpose
We performed a systematic review to determine which host factors play a role in the development of clinical and/or radiographic failure from aseptic loosening after (1) THA and (2) TKA.Methods
Two searches on THA and TKA, respectively, using four electronic databases (EMBASE, CINAHL Plus, PubMed, and Scopus) were conducted. We identified a total of 209 reports that encompassed nine potential host factors affecting aseptic loosening. Inclusion criteria for consideration of scientific clinical reports were that 20 or more patients were involved, with more than 1-year followup, with at least three studies pertaining to each factor, and at least six of the Methodological Index for Non-randomized Studies criteria met, and with raw data for odds ratio (OR) calculations. Twenty-one studies (16 THA studies with 45,779 hips and five TKA studies with 288 knees, respectively) were used to calculate weighted OR and CIs (using the random effects theory) and study heterogeneity for four different host factors in THAs (male sex, high activity level, obesity defined as BMI ≥ 30 kg/m2, and current or former tobacco use) and one factor in TKA (BMI ≥ 30 kg/m2), which were placed in a forest plot.Results
For THA, male sex (OR, 1.39; 95% CI, 1.22–1.58; p = 0.001) and high activity level (University of California Los Angeles [UCLA] activity score ≥ 8 points; OR, 4.24; 95% CI, 2.46–7.31; p = 0.001) were associated with aseptic loosening. However, obesity (OR, 1.01; 95% CI, 0.73–1.40; p = 0.96), and tobacco use (OR, 1.96; 95% CI, 0.43–8.97; p = 0.39) were not associated with an increased risk of aseptic loosening after THA with the numbers available. For TKA, we found no host factors associated with loosening. In particular, obesity (BMI ≥ 30 kg/m2) was not associated with aseptic loosening with the numbers available (OR, 2.28; 95% CI, 0.60–8.62; p = 0.22).Conclusions
Patients undergoing a lower-extremity total joint arthroplasty who engage in impact sports should be counseled regarding their potential increased risk of aseptic loosening; however, given the weak evidence available, we believe that higher-level studies are necessary to clearly define the risk factors, particularly with newer-generation constructs.Level of Evidence
Level IV, therapeutic study. 相似文献16.
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Adolph V. Lombardi Jr Keith R. Berend Michael J. Morris Joanne B. Adams Michael A. Sneller 《Clinical orthopaedics and related research》2015,473(2):509-520
Background
Use of large-diameter metal-on-metal (MoM) articulations in THA increased, at least in part, because of the possibility of achieving improved joint stability and excellent wear characteristics in vitro. However, there have been subsequent concerning reports with adverse reactions to metal debris (ARMD), pseudotumors, and systemic complications related to metal ions.Questions/purposes
The purpose of this study was to determine at a minimum of 2 years’ followup (1) the proportion of patients who experienced a dislocation; (2) the short-term survivorship obtained with these implants; (3) the causes of failure and the proportion of patients who developed ARMD; and (4) whether there were any identifiable risk factors for revision.Methods
We reviewed the results of 1235 patients who underwent 1440 large-diameter MoM primary THAs at our institution using two acetabular devices from a single manufacturer with minimum 2-year followup. Large-diameter MoM devices were used in 48% (1695 of 3567) of primary THAs during the study period. We generally used these implants in younger, more active, higher-demand patients, in patients considered at higher risk of instability, and in patients with adequate bone stock to achieve stable fixation without use of screws. Clinical records and radiographs were reviewed to determine the incidence and etiology of revision. Patients whose hips were revised were compared with those not revised to identify risk factors; Kaplan-Meier survivorship analysis was performed as was multivariate analysis to account for potential confounding variables when evaluating risk factors. Minimum followup was 2 years (average, 7 years; range, 2–12 years); complete followup was available in 85% of hips (1440 of 1695).Results
Dislocation occurred in one hip overall (< 1%; one of 1440). Kaplan-Meier analysis revealed survival free of component revision was 87% at 12 years (95% confidence interval, 84%–90%). The two most common indications for revision were ARMD (48%; 47 of 108 hips revised) and loosening or failure of ingrowth (31%; 34 of 108). Risk factors for component revision were younger age at surgery (relative risk [RR] 0.98 per each increased year; p = 0.02), higher cup angle of inclination (RR 1.03 per each increased degree; p = 0.04), and female sex (RR 1.67; p = 0.03).Conclusions
Large-diameter MoM THAs are associated with a very low dislocation rate, but failure secondary to ARMD and loosening or lack of ingrowth occur frequently. Patients with MoM THA should be encouraged to return for clinical and radiographic followup, and clinicians should maintain a low threshold to perform a systematic evaluation. Early diagnosis and appropriate treatment are recommended to prevent the damaging effects of advanced ARMD.Level of Evidence
Level IV, Therapeutic study. 相似文献18.
What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR
James Min-Leong Wong Yen-Liang Liu Stephen Graves Richard de Steiger 《Clinical orthopaedics and related research》2015,473(11):3458-3464
Background
More than 15,000 primary hip resurfacing arthroplasties have been recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with 884 primary procedures requiring revision for reasons other than infection, a cumulative percent revision rate at 12 years of 11%. However, few studies have reported the survivorship of these revision procedures.Questions/purposes
(1) What is the cumulative percent rerevision rate for revision procedures for failed hip resurfacings? (2) Is there a difference in rerevision rate among different types of revision or bearing surfaces?Methods
The AOANJRR collects data on all primary and revision hip joint arthroplasties performed in Australia and after verification against health department data, checking of unmatched procedures, and subsequent retrieval of unreported procedures is able to obtain an almost complete data set relating to hip arthroplasty in Australia. Revision procedures are linked to the known primary hip arthroplasty. There were 15,360 primary resurfacing hip arthroplasties recorded of which 884 had undergone revision and this was the cohort available to study. The types of revisions were acetabular only, femoral only, or revision of both acetabular and femoral components. With the exception of the acetabular-only revisions, all revisions converted hip resurfacing arthroplasties to conventional (stemmed) total hip arthroplasties (THAs). All initial revisions for infection were excluded. The survivorship of the different types of revisions and that of the different bearing surfaces used were estimated using the Kaplan-Meier method and compared using Cox proportional hazard models. Cumulative percent revision was calculated by determining the complement of the Kaplan-Meier survivorship function at that time multiplied by 100.Results
Of the 884 revisions recorded, 102 underwent further revision, a cumulative percent rerevision at 10 years of 26% (95% confidence interval, 19.6–33.5). There was no difference in the rate of rerevision between acetabular revision and combined femoral and acetabular revision (hazard ratio [HR], 1.06 [0.47–2], p = 0.888), femoral revision and combined femoral and acetabular revision (HR, 1.00 [0.65–2], p = 0.987), and acetabular revision and femoral revision (HR, 1.06 [0.47–2], p = 0.893). There was no difference in the rate of rerevision when comparing different bearing surfaces (metal-on-metal versus ceramic-on-ceramic HR, 0.46 [0.16–1.29], p = 0.141; metal-on-metal versus ceramic-on-crosslinked polyethylene HR, 0.51 [0.15–1.76], p = 0.285; metal-on-metal versus metal-on-crosslinked polyethylene HR, 0.62 [0.20–1.89], p = 0.399; and metal-on-metal versus oxinium-on-crosslinked polyethylene HR, 0.53 [0.14–2.05], p = 0.356).Conclusions
Revision of a primary hip resurfacing arthroplasty is associated with a high risk of rerevision. This study may help surgeons guide their patients about the outcomes in the longer term after the first revision of hip resurfacing arthroplasty.Level of Evidence
Level III, therapeutic study. 相似文献19.
Derek F. Amanatullah Louis Stryker Perry Schoenecker Michael J. Taunton John C. Clohisy Robert T. Trousdale Rafael J. Sierra 《Clinical orthopaedics and related research》2015,473(2):685-691
Introduction
Some patients opt to undergo conversion to a THA for continued pain or progression of hip arthritis after periacetabular osteotomy. Whether patients are at greater risk for postoperative complications, revision THA, poor clinical outcomes, or compromised radiographic results after periacetabular osteotomy is debatable.Questions/purposes
When compared with a matched cohort of patients who underwent THAs for developmental dysplasia of the hip (DDH) without previous periacetabular osteotomy, we asked whether a THA after a periacetabular osteotomy has (1) a higher complication rate, (2) a higher likelihood of resulting in revision THA, (3) comparable improvements in Harris hip score, and (4) comparable radiographic results.Patients and Methods
A multicenter retrospective review of 562 patients undergoing 645 periacetabular osteotomies was performed. Twenty-three hips in 22 patients underwent a THA after periacetabular osteotomy. The patients were matched for age, sex, and BMI with 23 hips in 23 patients with DDH undergoing THA without a history of periacetabular osteotomy. Minimum followup for both groups of patients was 2 years (mean, 10 ± 4 years and 6 ± 4 years, respectively). Comparisons were made to answer the study questions based on a retrospective review from prospectively maintained registries of clinical and radiographic information at two participating centers.Results
With the numbers available, there was no difference in complication or revision rates between the two groups (p = 0.489 and 1.000, respectively); however, a post hoc power analysis showed our study was underpowered to detect a difference in the rate of postoperative complications or revision THA. There was marked improvement in Harris hip score with THA after periacetabular osteotomy (p < 0.001) and THA for DDH (p < 0.001), but there was no difference (p = 0.265) in the Harris hip score at final followup between either group. The acetabular component was placed at a mean of 17° more retroversion during THA after periacetabular osteotomy compared with THA for DDH (p = 0.002).Conclusions
This study did not detect any differences in the clinical outcomes in patients undergoing THA after periacetabular osteotomy done with a modern abductor-sparing approach when compared with a matched cohort undergoing THA for DDH. However, even with patients tallied across two high-volume centers during nearly 15 years, our study was underpowered to detect potentially important differences between the THA after periacetabular osteotomy group and the THA for DDH group. The data in this report are suitable as pilot data for future studies and for systematic reviews. Larger multicenter studies are needed to understand how the technical challenges of THA after periacetabular osteotomy affect postoperative complications and revision THA.Level of Evidence
Level III, therapeutic study. 相似文献20.
Jacques H. Caton Jean Louis Prudhon André Ferreira Thierry Aslanian Régis Verdier 《International orthopaedics》2014,38(6):1125-1129