Impaction grafting

Background An increased incidence of osteonecrosis of the femoral head has been reported in patients infected with human immunodeficiency virus (HIV). The purpose of this study was to review the pathologic specimens of HIV-positive patients who had undergone total hip arthroplasty (THA) and compare them with those of THA patients who were HIV-negative. The surgical outcomes of these HIV-positive patients were also reviewed.

Methods 40 HIV-positive patients who underwent 54 THAs at our institution were identified. The primary pathologic diagnosis for the femoral heads of these patients was osteonecrosis in 35 cases, degenerative joint disease in 11 cases, and other diagnoses in 8 cases.

Results There was a higher incidence of osteonecrosis in HIV-positive patients. At the most recent follow-up, 4 patients had died and 1 patient had a significant Staphylococcus aureus infection of the hip.

Interpretation There was a significant difference in the pathologic diagnoses of the HIV-positive group and the HIV-negative group, implicating HIV infection as a risk factor for osteonecrosis. Also, the risk of infectious complications is lower in our study than previously reported in other studies of HIV-positive patients who have undergone THA.     

Association between human immunodeficiency virus and osteonecrosis of the femoral head

The records of a consecutive series of 50 patients treated operatively for osteonecrosis of the femoral head were reviewed to determine the prevalence of human immunodeficiency virus (HIV) as an isolated risk factor for osteonecrosis. Twelve patients had a history of trauma to the hip and were excluded from the study. The remaining 38 patients were treated operatively for nontraumatic osteonecrosis of the femoral head. Of these, 7 patients were HIV positive, and 31 were HIV negative. Of the 7 patients who were HIV positive, 4 (57%) had none of the known risk factors for osteonecrosis. Of the 31 patients who were HIV negative, 4 (13%) had none of the known risk factors for osteonecrosis. The difference between the groups was statistically significant, suggesting that HIV infection is a risk factor for the development of osteonecrosis of the femoral head.     

Hip Osteonecrosis: Does Prior Hip Surgery Alter Outcomes Compared to an Initial Primary Total Hip Arthroplasty?

The purpose of this study was to assess the clinical and radiographic outcomes of total hip arthroplasty (THA) in patients who had osteonecrosis to see if prior hip preserving surgery affected outcomes. Implant survivorship, Harris hip scores, and radiographic outcomes were compared between 87 patients (92 hips) who had undergone prior hip preserving procedures and 105 patients (121 hips) who had only undergone THA. Patients were also sub-stratified into low- and high-risk groups for osteonecrosis. At a mean follow-up of 75 months, there were no significant differences in survivorship, clinical, and radiographic outcomes among the cohorts. Higher revision rates were associated with patients who were in the high-risk group. The authors believe that hip joint preserving procedures may not adversely affect the outcomes of later THA in patients with osteonecrosis.     

Total Hip Arthroplasty After Failed Internal Fixation of Proximal Femoral Fractures

Between February 1987 and October 2008, we performed 102 total hip arthroplasties (THAs) after failed internal fixation of a prior hip fracture. There were 39 intertrochanteric fractures and 63 femoral neck fractures. Etiology of failure included 35 cases of osteonecrosis, 32 cases of arthritis, 25 cases of early failure of fixation, and 10 cases of nonunion. There were 12 patients who had early surgical complications related to the procedure (11.8%, 12/102). These included 5 patients who had dislocations (4.9%), 4 periprosthetic fractures (3.9%), 2 hematomas (2.0%), and 1 infection (1%). Of these 102 THAs, 50 were available for at least 2 years of follow-up (mean, 3.2 years). At a minimum 2-year follow-up, THA after failed internal fixation of hip fracture in these patients was clinically successful with an elevated risk of periprosthetic fracture and dislocation.     

Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head

BACKGROUND: Osteonecrosis of the femoral head, a disease primarily affecting young adults, is often associated with collapse of the articular surface and subsequent arthrosis. Free vascularized fibular grafting has been reported to be successful for patients with early stages of osteonecrosis, but little is known about its efficacy after the femoral head has collapsed. METHODS: We retrospectively reviewed the results in a consecutive series of 188 patients (224 hips) who had undergone free vascularized fibular grafting, between 1989 and 1999, for the treatment of osteonecrosis of the hip that had led to collapse of the femoral head but not to arthrosis. The average duration of follow-up was 4.3 years (range, two to twelve years). We defined conversion to total hip arthroplasty as the failure end point, and we analyzed the contribution, to failure, of the size of the lesion, amount of preoperative collapse of the femoral head, etiology of the osteonecrosis, age of the patient, and bilaterality of the lesion. We used the Harris hip score to evaluate clinical status preoperatively and at the time of the most recent follow-up. RESULTS: The overall rate of survival was 67.4% for the hips followed for a minimum of two years and 64.5% for those followed for a minimum of five years. The mean preoperative Harris hip score was 54.5 points, and it increased to 81 points for the patients in whom the surgery succeeded; 63% of the patients in that group had a good or excellent result. There was a significant relationship between the outcome of the grafting procedure and the etiology of the osteonecrosis (p = 0.017). Patients in whom the osteonecrosis was idiopathic, associated with alcohol abuse, or posttraumatic fared worse than did those with other causes, including steroid use. Survival of the joint was not significantly related to the size of the femoral head lesion, but there was an increased relative risk of conversion to total hip arthroplasty with increasing lesion size and amount of collapse. Neither patient age nor bilaterality significantly affected outcome. CONCLUSIONS: Patients with postcollapse, predegenerative osteonecrosis of the femoral head appear to benefit from free vascularized fibular grafting, with good overall survival of the joint and significant improvement in the Harris hip score. The results of this femoral head-preserving procedure in patients with postcollapse osteonecrosis are superior to those of core decompression and nonoperative treatment, as reported in the literature. Patients with larger lesions and certain diagnoses, such as idiopathic and alcohol-related osteonecrosis, have worse outcomes.     

Outcomes of Total Hip Arthroplasty in Human Immunodeficiency Virus-Positive Patients

Today, patients with human immunodeficiency virus (HIV) live long enough to develop chronic degenerative and HIV-associated joint disease. There is a growing population of patients infected with HIV who are candidates for total hip arthroplasty (THA). A total of 31 HIV-positive, non-hemophilic patients undergoing 41 THAs at our institution between 2000 and 2012 were identified. In-hospital medical complications were reported in 5 of 41 hips, all of which resolved prior to discharge. Deep infection developed in 1 of 41 hips and revision was required in 3 of 41 hips. These results suggest that low rates of complications and revision can be achieved in the HIV-positive, non-hemophilic population. We believe that with careful patient selection, THA may improve the quality of life in the HIV-positive population.     

Osteonecrosis of the femoral head after solid organ transplantation: a prospective study

BACKGROUND: The reported prevalence of osteonecrosis of the femoral head in patients who have undergone a solid organ transplant has ranged from 3% to 41%. The wide variation is due to the retrospective nature of most studies and the inability to capture data on asymptomatic patients. The primary goals of this study were to determine the true prevalence of osteonecrosis of the femoral head following solid organ transplantation, the time to the development of the osteonecrosis, and whether findings on magnetic resonance imaging precede the onset of symptoms. METHODS: Beginning in 1997, patients who had undergone a solid organ transplant were asked to participate in a prospective study in which they would be screened for osteonecrosis of the femoral head. Inclusion criteria included an age of greater than fourteen years, a first-time transplant, and magnetic resonance imaging performed within six months after the transplant. Exclusion criteria were pre-existing osteonecrosis of the femoral head in the hip included in the study, a history of inflammatory arthritis, previous hip surgery, any contraindication to magnetic resonance imaging, a prior organ transplant, prior systemic corticosteroid treatment, and mental health issues preventing adequate follow-up. Screening magnetic resonance imaging was performed every four months. Survivorship analysis was used to determine the prevalence of osteonecrosis of the femoral head. RESULTS: Fifty-two patients (103 hips) were enrolled in the study. Their ages ranged from twenty-four to sixty-five years (mean, forty-three years). Sixteen patients were dropped from the study, but the data collected on them before they were dropped were included in the analysis. Osteonecrosis of the femoral head was diagnosed in eight of the 103 hips. Survivorship analysis revealed that, at one year after the transplant, 89% +/- 7% of the hips and 80% +/- 13% of the patients were free of osteonecrosis of the femoral head; thus the prevalence of osteonecrosis one year after transplantation was 11% or 20%, respectively. The mean duration of follow-up of the remaining hips was 2.3 years. In two hips the osteonecrosis of the femoral head was seen on the initial screening magnetic resonance imaging, and in the other six it developed after the initial magnetic resonance imaging revealed negative findings. All cases of osteonecrosis of the femoral head developed within ten months after the transplant. Seven of the eight hips were asymptomatic at the time of diagnosis. There was a significant difference in the one-year osteonecrosis-free survival rate between the patients who were less than forty years old (78%) and those who were at least forty years old (97%) (p = 0.011). Diabetes, smoking, and rejection episodes were not risk factors for osteonecrosis of the femoral head. CONCLUSIONS: Our study of patients who had had a solid organ transplant revealed that the true prevalence of osteonecrosis of the femoral head in such patients is lower than that reported in most previous studies, osteonecrosis of the femoral head develops prior to the onset of symptoms, an age of less than forty years is a risk factor for osteonecrosis of the femoral head, and osteonecrosis of the femoral head develops within one year after transplantation. We recommend that magnetic resonance imaging be used to screen for osteonecrosis of the femoral head within one year after transplantation. The utility of additional magnetic resonance imaging after one year has not been established.     

Comparison of offset in Birmingham hip resurfacing and hybrid total hip arthroplasty

Hip resurfacing is being performed more frequently in the United Kingdom. The possible benefits include more accurate restoration of leg length, femoral offset and femoral anteversion than occurs after total hip arthroplasty (THA). We compared anteroposterior radiographs from 26 patients who had undergone hybrid THA (uncemented cup/cemented stem), with 28 who had undergone Birmingham Hip Resurfacing arthroplasty (BHR). We measured the femoral offset, femoral length, acetabular offset and acetabular height with reference to the normal contralateral hip. The data were analysed by paired t-tests. There was a significant reduction in femoral offset (p = 0.0004) and increase in length (p = 0.001) in the BHR group. In the THA group, there was a significant reduction in acetabular offset (p = 0.0003), but femoral offset and overall hip length were restored accurately. We conclude that hip resurfacing does not restore hip mechanics as accurately as THA.     

晚期股骨头坏死的人工关节置换术

[目的]探讨晚期股骨头坏死患者髋关节置换术的选择方法及其临床结果。[方法]对本科于1985年5月～2003年12门行髋关节置换术的119例（138髋）股骨头坏死患者进行了随访。使用人工双极股骨头置换术及THA治疗晚期股骨头坏死者分别为29例（31髋），90例（107髋）。所有手术均采用后外侧人路。[结果]早期使用的国产骨水泥人工双极股骨头假体，86．7％的股骨柄假体出现松动。全骨水泥THA，50％髋出现了髋臼杯似体松动，62．5％髋股骨柄似体松动，25％髋行全髋人工关节翻修术：混合型（Hybrid）THA，未出现髋臼杯及股骨柄似体的松动，非骨水泥THA，除1例外无髋臼杯及股骨柄假体松动或下沉。[结论]使用人工双极股骨头置换术治疗晚期股骨头坏死应慎重选择，可适用于老年、日常活动量小的患者；而对于年轻患者，非骨水泥型THA为最佳选择；对于股骨侧出现骨质疏松或不适合使用生物固定型股骨柄假体的患者，混合型（Hybrid）THA同样可以获得满意疗效；全骨水泥犁THA应很少使用。     

Osteonecrosis is not a predictor of poor outcomes in primary total hip arthroplasty: a systematic literature review

The primary goals of this critical literature review were to determine whether revision rates of primary total hip arthroplasty in patients with osteonecrosis differ based on the underlying associated risk factors and diagnoses, whether the outcomes of this procedure have improved over the past two decades, and to compare outcomes based on study level of evidence. A systematic literature review yielded 67 reports representing 3,277 hips in 2,593 patients who had a total hip arthroplasty for osteonecrosis of the femoral head. Stratification of outcomes by associated risk factors or diagnoses revealed significantly lower revision rates in patients with idiopathic disease, systemic lupus erythematosus, and after heart transplant, and significantly higher rates in patients with sickle cell disease, Gaucher disease, or after renal failure and/or transplant. There was a significant decrease in revision rates between patients operated upon before 1990 versus those in 1990 or later, with rates of 17% and 3%, respectively. The results for arthroplasties performed in 1990 or later were similar to those for all hips in publicly reported national joint registries. Certain risk factors were associated with higher revision rates in patients with osteonecrosis who were treated by total hip arthroplasty. However, most patients (82%) do not have these associated negative risk factors. Overall, this critical literature review provides evidence that osteonecrosis itself, or when associated with the most common risk factors and/or diagnoses, is not associated with poor outcomes in total hip arthroplasty.     

Vascularized Fibular Grafting for Osteonecrosis of the Femoral Head With Unusual Indications

We retrospectively reviewed the charts of 154 patients of various subgroups treated with the free vascularized fibular graft procedure for osteonecrosis of the femoral head (ONFH), evaluating pre- and postoperative Harris hip scores, hip range of motion, radiographs, and number of conversions to total hip arthroplasty (THA). Patients were followed a minimum of 1 year (mean, 6.8 years, range, 1 to 19 years). Athletes and patients with pyarthrosis-related osteonecrosis had high Harris hip scores at final review with scores of 94 and 97, respectively. Patients with ONFH after a slipped capital femoral epiphysis or following pregnancy had a low conversion rate to THA at 6% and 8%, respectively. Twenty-five percent of patients with transplant-related osteonecrosis of the femoral head were converted to THA at an average of 2.7 years. However, with select subsets of patients (athletes, pregnancy, organ transplant, femoral neck non-union, slipped capital femoral epiphysis, infection) the FVFG can result in a high rate of success.     

Satisfactory results of Stanmore total hip arthroplasty after failed osteosynthesis of the femoral neck

Treatment of fractures of the femoral neck by closed reduction and internal fixation results in a high incidence of complications, and often requires secondary total hip arthroplasty. We retrospectively studied 31 patients who underwent a Stanmore (Howmedica) total hip arthroplasty performed five months (median) after osteosynthesis. The most common indications were: failure of fixation (n = 14), osteonecrosis (n = 9) and secondary osteoarthritis (n = 6). Eight patients had a maximum follow-up of 12 months; the median follow-up was 30 months in the remaining group of 23 patients. Although one patient had radiographical signs of femoral loosening, none of the patients studied needed revision of the total hip arthroplasty. Using the Merle d'Aubigné scoring system, we found excellent results in 94% of the cases. Despite the short-term follow-up and the small number of patients, we conclude that the Stanmore THA was a satisfactory salvage procedure after failure of internal fixation for femoral neck fracture.     

Operations about Hip in Human Immunodeficiency Virus-Positive Patients

Background

The number of human immunodeficiency virus (HIV)-infected patients is increasing constantly, and it is well known that there is a significantly high prevalence of osteonecrosis of the femoral head in HIV-infected patients. Therefore, it is important to develop methods that can ensure the safety of both the patients and medical personnel who participate in surgery on HIV-infected patients. Recently, the authors performed 8 procedures on 5 HIV-infected patients. This paper reports our experience.

Methods

This study examined the medical records and radiological studies of 5 HIV-infected patients who had undergone surgery around the hip joint from January, 2005 to September, 2007. During the procedures, their mean age was 38.6 years (range, 23 to 53 years) and all were male. Four of them were under an anti-retroviral therapy program. The reasons for the operations were nonunion of the femoral shaft after trauma in two patients and osteonecrosis of both femoral heads in three. One autologous bone grafting, one screw fixation with autologous bone grafting, five total hip replacement arthroplasties, and one multiple drilling were performed. All procedures were carried out according to the guidelines of HIV infection control made by the Korea Centers for Disease Control and Prevention. The mean follow-up period was 16.6 months (range, 4 to 37 months).

Results

The preoperative CD4 count was 130 in one patient, and 200 to 499 in the other 4. The viral loads were 15100 and 420 in two patients, and negative in the other 3. Bony union was achieved in those who had undergone autologous bone grafting. There were significant improvements in both the Harris Hip Score and functional state in those who had total hip replacement arthroplasty. There were no immediate postoperative complications, such as infection. During the follow-up period, one patient died from esophageal variceal bleeding. However, no surgery-related complications were observed in the other 4 patients.

Conclusions

There were no significant complications in HIV-infected patients after the operations around the hip joint when their preoperative immunity was optimal. In addition, the safety of medical personnel can be assured when the operation is performed in line with the guidelines of HIV infection control.     

Evaluation of core decompression for early osteonecrosis of the femoral head

Twenty-six hips (19 patients) with osteonecrosis of the femoral head with stage I or II of the disease, according to the Ficat and Arlet classification, underwent core decompression. Osteonecrosis was confirmed histologically in all 26 hips. Of 19 patients, 7 had prognostic factors traditionally associated with poor outcome including collagen vascular disease and continued use of steroids. The follow-up period averaged 7 years 10 months (range: 2 years 5 months–13 years 8 months) for 17 patients with 24 hips. Two patients died secondary to systemic illness. Seventeen hips (65.4%) had very good or good results using the Ficat criteria. Eight hips (30.8%) needed further operation [total hip arthroplasty (THA) for 7 hips, osteotomy for 1 hip]. Of the 12 hips in patients who had used steroids, 6 hips (50%) were converted to THA. Four hips in patients with systemic lupus erythematosus (SLE) needed THA (100%). We conclude that core decompression provides an effective treatment for steroid-associated osteonecrosis other than in cases with SLE, as well as providing effective treatment for non-steroid-associated osteonecrosis in the early stages of the disease. Received: 28 July 1999     

Short term results of cementless total hip arthroplasty in sicklers

Background:Sickle cell (SC) disease leading to endarteritis induces skeletal changes in the form of osteitis, sclerosis of femoral canal and osteonecrosis of the femoral head. All these make total hip arthroplasty (THA) difficult and prolonged. There is increased risk of infection, SC crisis and increased complication rate. Our paper aims to highlight preoperative, intraoperative and postoperative hurdles encountered in performing THA in sicklers and the short term outcome using cementless implants.Results:The average operating time was 96 min (range 88–148 min). The average blood loss was 880 ml (range 650–1200 ml). The average intraoperative blood transfused was 2.3 units (range 2–5 units). All patients showed an improvement in Harris hip score from 42 points preoperatively to 92 points at latest followup. Intraoperatively, one patient had a periprosthetic fracture. Six patients developed acute SC crisis and were managed in intensive care unit. Three patients developed wound hematoma. Three patients developed limb length discrepancy less than 1 cm. None had early or late dislocations, infection, heterotopic ossification, sciatic nerve palsy and aseptic loosening.Conclusion:THA in sicklers involves considerable challenge for the orthopedic surgeon. Management requires a multidisciplinary approach involving the anesthetist, hematologist and the orthopedic surgeon. Contrary to previous reports, THA in sicklers now has a predictable outcome especially with the use of cementless implants.     

Cementless total hip arthroplasty with ceramic-on-ceramic bearing in patients younger than 45 years with femoral-head osteonecrosis

Despite improvements in the quality of alumina ceramics, osteolysis has been reported anecdotally after total hip arthroplasty (THA) with use of a contemporary alumina-on-alumina ceramic bearing. The purpose of this study was to evaluate the clinical and radiographic outcomes of THA using alumina-on-alumina ceramic bearing and to determine osteolysis using radiographs and computed tomographic (CT) scans in young patients. Consecutive primary cementless THA using alumina-on-alumina ceramic bearing were performed in 64 patients (93 hips) who were younger than 45 years of age with femoral-head osteonecrosis. There were 55 men (84 hips) and nine women (nine hips). Average age was 38.2 (range 24–45) years. Average follow-up was 11.1 (range 10–13) years. Preoperative Harris Hip Score was 52.9 (range 22–58) points, which improved to 96 (range 85−100) points at the final follow-up examination. Two of 93 hips (2%) had clicking or squeaking sound. No hip had revision or aseptic loosening. Radiographs and CT scans demonstrated that no acetabular or femoral osteolysis was detected in any hip at the latest follow-up. Contemporary cementless acetabular and femoral components with alumina-on-alumina ceramic bearing couples function well with no osteolysis at a ten year minimum and average of 11.1-year follow-up in this series of young patients with femoral-head osteonecrosis.     

Long-Term Results of Cementless Total Hip Arthroplasty for Patients With High Hip Dislocation After Childhood Pyogenic Infection

BackgroundThe purpose of this study is to analyze the 10-year outcomes of cementless, modular total hip arthroplasty (THA) in adult patients who had high dislocation secondary to childhood pyogenic arthritis.MethodsWe retrospectively followed 56 consecutive patients who underwent cementless, modular THA for the late sequelae of childhood septic arthritis of the hip from 2001 to 2011. There were 23 men and 33 women with a mean age of 47 years (24 to 68). Of the 56 hips, 25 were classified as Crowe type III and 31 as type IV. Mean follow-up was 10.7 years.ResultsOne hip with a quiescent period of 23 years had recurrence of infection. Revision surgery was performed in 2 patients because of loosening and breakage of femoral stem and new infection with no correlation with childhood sepsis, respectively. The mean Harris hip scores improved from 44.2 points preoperatively to 87.5 points at final follow-up. Similarly, the Hip dysfunction and Osteoarthritis Outcome Score and hip pain also significantly improved at the latest follow-up. The mean acetabular cup abduction was 40.8° and the mean anteversion 27.8°, respectively. There were 5 cases of transient nerve palsy and 5 cases of intraoperative fracture.ConclusionTHA can reliably restore the abnormal anatomy and provide good results in these young and active patients who had high hip dislocation secondary to childhood pyogenic arthritis with a relatively high incidence of complications. However, these complications can be treated.     

混合型初次全髋关节置换术中骨水泥柄10年以上的随访研究

目的回顾性分析混合型初次全髋关节置换术（THA）中骨水泥柄的临床和影像学疗效及其相关影响因素。方法对1999年1月至2001年12月期间接受混合型初次THA治疗髋部疾病的患者126例（135髋）进行至少10年的随访。观察Harris评分、股骨假体位置、骨水泥壳及其周围骨质变化。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动导致翻修及单纯骨溶解病灶清除植骨术为随访终点。结果共有79例（85髋）获得10年以上随访。Harris评分由术前（44.5±18.8）分提高至末次随访时（92.1±5.6）分。截至随访终点,在Gruen 1区观察到2髋发生骨溶解,7区4髋发生骨溶解现象。共有4例（4髋）接受翻修手术,其中1例男性患者因骨溶解致髋臼假体松动,同侧股骨近端骨溶解,同期行右髋臼侧翻修及股骨侧骨溶解病灶清除植骨术。另3例因髋臼假体松动行髋臼侧翻修术,影像学及术中见股骨假体稳定。以无菌性松动为随访终点,股骨假体生存率为100%;以无菌性松动翻修、单纯骨溶解病灶清除植骨术为随访终点,股骨假体生存率为98.8%（95%可信区间,12.23~12.32）。结论混合型初次THA术中骨水泥假体的远期生存率令人满意;采用第3代骨水泥技术固定的股骨柄取得与现代非骨水泥假体柄相近的远期生存率。     

258髋Corail股骨柄假体中期疗效观察

目的：探讨终末期髋关节疾病患者采用 Corail 羟基磷灰石(Hydroxyapatite,HA)全涂层股骨柄假体行全髋关节置换术(Total hip arthroplasty, THA)的中期疗效。方法：回顾性分析2011年 1 0月～2019 年 10月采用 Corail 假体行 THA 治疗 239例（258髋）髋关节终末期疾病患者的病例资料,其中男137例,女102例,年龄38~79岁,平均50.4岁。左髋117例,右髋141例。适应症包括股骨头缺血性坏死145髋（56.2%）,髋关节发育不良58髋（22.4%）,髋关节骨性关节炎36髋（14.0%）,股骨颈骨折11髋（4.3%）,类风湿关节炎8髋（3.1%）。采用 Harris 评分、疼痛视觉模拟评分（VAS）及临床并发症评估患者髋关节功能,随访X 片观察假体有无松动、螺钉有无断裂等。结果：所有患者均安全度过围手术期。术后1例患者出现肺部感染伴胸腔积液,术后6例患者术侧大腿出现了不同程度的疼痛,术后5例患者出现假体感染,术后6例患者出现脱位,术后7例患者出现小腿肌间静脉血栓,术后15例患者出现了假体下沉,未出现无菌性松动或神经血管损伤等并发症,无翻修患者,股骨柄存活率为100%。术后239例（258髋）均获随访,随访时间0.5~7年,平均5.8年,末次随访Harris评分（84.84±5.65）分、VAS评分（1.11±0.79）,所有的股骨柄都非常稳定,没有透亮线的迹象。结论：Corail HA 全涂层股骨柄假体具有持久的稳定性,术后大腿疼痛发生率较低等优点,中期疗效较好。     

Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study

Background

Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain.

Questions/Purposes

The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR.

Methods

After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position.

Results

Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain.

Conclusion

In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.