陶瓷-陶瓷髋关节置换术髋臼假体放置角度对中期临床疗效的影响

目的探讨陶瓷-陶瓷髋关节置换术中髋臼假体放置角度对中期临床疗效的影响。方法将进行第四代陶瓷-陶瓷髋关节置换术的60例患者随机分为两组,其中试验组髋臼假体放置角度为30°~40°,对照组髋臼假体放置角度为40°~50°。所有患者术前行Harris髋关节评分,术后6、12个月及每隔1年进行随访,进行Harris髋关节评分、术后疼痛持续时间、术后拐杖使用时间、并发症发生率、基于X线片的内植物情况分析(假体碎裂、假体柄下沉、髋臼杯移位、假体周围骨质等)及髋关节功能状况等调查。结果所有患者术后5年Harris髋关节评分均较术前明显增高,试验组Harris髋关节评分较对照组明显增高(P<0.05)。试验组术后疼痛持续时间为(3.14±0.37)d,对照组为(3.13±0.35)d,两者无统计学差异(P>0.05);试验组术后拐杖使用时间为(14.83±1.63)d,对照组为(15.32±2.64)d,两者无统计学差异(P>0.05);试验组术后平均住院日为(4.93±0.38)d,对照组为(4.85±0.64)d,两者无统计学差异(P>0.05)。术后5年,两组患者异位骨化及股骨假体松动发生率无统计学差异(P>0.05),试验组患者假体碎裂、髋臼杯松动发生率较对照组明显降低(P<0.05)。结论陶瓷-陶瓷髋关节置换术中适当降低髋臼杯外展角对于假体远期生存率具有较好的意义。     

基于单元的综合安全项目对手术室护士髋关节假体产品应用安全的影响

目的 探讨基于单元的综合安全项目的实施对手术室护士人工全髋关节置换术中髋关节假体产品应用安全的影响。方法 将骨科手术间的49名手术室护士按照区域分为对照组24名,试验组25名。对照组实施常规安全管理模式,试验组实施基于单元的综合安全项目对护士髋关节假体产品应用进行安全管理,3个月后对两组护士髋关节假体产品应用知识水平及安全态度得分进行评价,选取两区域各320例患者比较髋关节假体产品应用实际错误/堵漏事件发生率。结果 试验组护士髋关节假体产品应用知识测评成绩与安全态度得分显著高于对照组(均P<0.05),应用髋关节假体产品实际错误/堵漏事件发生率显著低于对照组(P<0.05)。结论 基于单元的综合安全项目的应用能够促进单元内安全文化的建立,提高单元内护士髋关节假体产品应用安全水平。     

生物型髋关节假体涂层脱落的临床分期和预防

目的:对于生物型髋关节长期的生物学效应是未知的.探讨生物型髋关节假体涂层脱落的原因和提出相应的预防和治疗措施具有重要临床意义.方法:自2002年10月至2009年2月,对5例生物型髋关节假体涂层脱落进行分析,采用全髋关节翻修术治疗.男3例,女2例;年龄55～68岁.术中取出假体进行分析,探讨涂层脱落发生的原因.对照组为翻修术取下的正常假体(10例).使用组织形态学观察断面的表面形态和微结构,并用电子数显外径千分尺测量碎片厚度,维式硬度计测量涂层的维式硬度(HV),以及Push-out试验测量界面抗剪切强度.对髋关节功能进行Harris评分.结果:对照组和试验组组织形态学观察有区别.2例HA涂层脱落患者涂层厚度分别为112、138μm;维氏硬度分别为5 843、4 524 Hv;抗剪切强度分别为12.4、11.6 MPa.3例钛珠涂层脱落患者术后Harris评分分别为82、88及87分.结论:多种原因可同时导致假体涂层脱落,但临床上碰到的涂层脱落的病例多与假体质量有关,现有各种方法可以明显提高涂层与假体之间的结合强度,从而预防涂层的早期脱落.     

早期国产生物型人工全髋关节置换术中远期疗效分析

[目的]探讨应用早期国产生物型人工全髋关节置换术(total hip arthroplasty,THA)的中远期疗效.[方法]自1997年10月～2004年3月,46例49髋不同病因的髋关节病变行国产生物型THA.通过临床效果及影像学分析治疗效果.[结果]46例平均随访时间8.5年(5～11.5年).Harris评分由术前38分(35～50分),提高到末次随访的82分(70～90分).影像学检查发现假体松动9髋,其中单纯髋臼松动3髋,股骨假体松动4髋,髋臼及股骨假体均松动2髋;脱位3例5次,1例为术毕回房搬动时发生,另外2例各2次为院外不当活动所致,均闭合复位成功.出现异位骨化1例,Brooker分级1级;1例出现髋部疼痛、跛行,X线片显示假体无明显松动,但骨质疏松明显,经抗骨质疏松治疗后症状缓解.无感染病例.优良率为73.9%.[结论]早期国产髋关节假体解决了患者的髋关节病痛,价格较低,缓解了患者的经济压力.同时,早期国产生物型髋关节假体在设计、工艺及配套器械方面有待改进,降低松动率,提高远期疗效.     

全髋关节置换术后翻修的原因分析

目的分析全髋关节置换术后行翻修手术的具体原因,并与以往文献报道的结果进行比较。方法回顾性分析自2014-01—2019-06完成的93例全髋关节翻修术,翻修术前均为初次单侧全髋关节置换术。将患者分为早期组(假体使用时间5年)和晚期组(假体使用时间≥5年),统计行翻修手术的原因,并对数据进行描述性分析。结果 45例(48.4%)全髋关节翻修原因为假体无菌性松动,19例(20.4%)为假体周围感染,15例(16.1%)为假体周围骨折,8例(8.6%)为聚乙烯内衬磨损,4例(4.3%)为髋关节反复脱位,髋关节疼痛、骨水泥游离体各1例。93例假体使用时间为(7.72±6.39)年,早期组38例,假体使用时间为(1.50±1.50)年;晚期组55例,假体使用时间为(12.02±5.09)年。早期组中13例假体周围感染,10例假体无菌性松动,9例假体周围骨折,4例髋关节反复脱位,1例聚乙烯内衬磨损,1例骨水泥游离。晚期组中35例假体无菌性松动,7例聚乙烯内衬磨损,6例假体周围感染,6例假体周围骨折,1例髋关节疼痛。结论假体无菌性松动是全髋关节置换术后最常见的翻修原因,随后依次为假体周围感染、假体周围骨折、聚乙烯内衬磨损、髋关节脱位等,这与国内外许多学者的研究一致。     

新型国产JHB人工髋关节置换临床应用初步报告

目的探讨新型国产非骨水泥固定人工关节(JHB)临床应用的近期疗效,进一步改善股骨头坏死的治疗效果.方法回顾性总结分析1999年3月～2002年10月在本院骨科施行JHB国产人工关节置换的79例(97例髋关节)股骨头缺血坏死患者的临床和X线随访资料.结果79例患者中3例(3髋)出现切口表浅感染,61例(76髋)获得随访的患者功能均满意,54例(68髋)无明显疼痛,52例能继续工作.59例X线片显示假体与髓腔及髋臼匹配良好,58例X线片(72髋)随访显示髋臼假体达到骨长入固定,3例(3髋)纤维稳定.股骨假体有3例(4侧)为纤维性稳定,其余为骨长入固定.3侧髋臼周围出现断续骨溶解,2侧股骨假体周围出现轻度骨溶解,均未影响假体的稳定性.Harris评分术前平均(44.12±11.74)分,末次随访评分(91.62±19.56)分.结论根据国人解剖特点设计的国产新型人工关节JHB假体与股骨髓腔及髋臼匹配、适应良好,表面处理有利于骨长入固定,用于治疗股骨头缺血坏死近期疗效满意.     

国产髋关节人工假体置换术后生存率的远期随访

目的：通过远期随访了解国产髋关节人工假体置换术后生存率。方法：对本组176例髋关节人工假体置换术后有回信和Harris评分的病例采用临床生存率进行统计。对X线资料完整的92例采用X线生存率进行统计。结果：本组176例的临床生存率：5年158例(90％)；10年130例(73％)；15年32例(18％)；20年12例(7％)。本组92例的X线生存率：5年57例(67％)；10年40例(44％)；15年10例(11％)；20年2例(1％)。在10～15年X线生存率50例中的年龄分布是50～60岁。这说明50～60岁是髋关节人工假体置换的较好适应证。另外，20年X线生存率和临床生存率的平均年龄是45岁。这也说明此年龄段的骨质和体质相对较好。在10年和15年X线生存率中男女比例无明显差异。但在5年和20年X线生存率中女性所占比例较大。可能与5年X线生存率的高龄女性骨质疏松和20年X线生存率中的女性活动量比男性相对较少有关。从20年临床生存率的12例中没有见到肥胖者，间接说明体重对假体磨损有一定影响。本组人工假体5年平均下沉4mm；10年平均下沉9mm；15年平均下沉13mm；20年平均下沉19mm；25年平均下沉22mm。平均每年下沉1mm。结论：从本组176例国产髋关节人工假体置换术后随访结果可以提示：80岁以上、合并其他疾病的高龄患者(特别是女性)国产髋关节人工假体置换术后生存率是5年左右；50～60岁而无其他疾病的患者国产髋关节人工假体置换术后生存率是10～15年左右；个别年龄相对较小(40～50岁)、体重较轻而无其他疾患、不从事重体力劳动而又经常体育锻炼的患者，其国产髋关节人工假体置换术后生存率可能达到20年。     

复合材料人工髋关节的实验研究

目的应力遮挡引起的股骨上段骨吸收和远期松动是影响人工髋关节远期疗效的主要原因之一.本实验对弹性模量接近皮质骨的聚砜复合材料及其人工髋关节进行了研究.方法用14只成年狗行右侧髋关节置换术,植入聚砜-碳纤维-羟基磷灰石复合材料假体.分术后当日、1月、3月、6月和9月组处死动物.通过单光子骨密度仪,X线摄片计算机辅助分析,光镜和扫描电镜分析,对假体植入后股骨上段骨重建变化和骨假体界面结合进行研究.结果显示复合材料假体应力遮挡轻,假体植入侧骨密度变化与对照组相比,无骨吸收.骨假体界面结合满意,1个月结合面积(45.61±2.75)%、3个月(50.26±2.19)%、6个月(51.24±1.07)%、9个月(54.02±4.08)%.结论聚砜复合材料假体有良好的力学相容性和生物相容性,是一种有前途的新型假体.     

不同假体髋关节置换术治疗骨质疏松性髋关节骨折的临床疗效

目的探讨不同假体髋关节置换术治疗骨质疏松性髋关节骨折的临床疗效。方法选取2013年4月~2015年12月我院收治的骨质疏松性髋关节骨折患者76例,随机分为两组,各38例,均行髋关节置换术,观察组行生物固定假体植入治疗,对照组行骨水泥假体植入治疗。比较两组预后情况。结果所有患者均顺利完成手术,无术中严重并发症发生。术后3个月观察组与对照组的Harris评分优良率分别为92.1%和68.4%,切口感染、神经损伤、肺部感染、下肢静脉血栓等并发症发生率分别为5.3%和28.9%,差异均有统计学意义(P0.05)。术后3个月观察组与对照组髋关节活动度分别为164.22°±22.16°和134.24°±19.92°,较术前的69.33°±15.29°和71.39°±16.02°明显改善(P0.05),且观察组明显优于对照组(P0.05)。结论相对于骨水泥型假体,基于生物型假体的下肢重建在骨质疏松性髋关节骨折置换术的应用能提高术后关节活动度,改善髋关节功能,减少并发症的发生,从而促进患者早日康复。     

S-ROM假体全髋关节置换治疗Crowe Ⅳ型髋关节发育不良

目的:探讨S-ROM假体全髋关节置换术治疗CroweⅣ型髋关节发育不良的方法并评价其疗效。方法:2000年10月至2011年10月,应用全髋关节置换术治疗CroweⅣ型髋关节发育不良患者30例36髋,其中6例双侧,24例单侧。采用S-ROM假体结合股骨转子下横断截骨短缩行人工关节置换术,髋臼侧均采用生物型假体,假体在真臼水平或接近于真臼水平植入。对临床结果采用改良Harris评分进行评价,术前及术后随访时均拍X线片进行观察。结果:30例中早期死亡l例(双髋),失访2例(2髋),余27例32髋获得随访,时间7～84个月,平均48个月。2髋分别于术后12、18个月随访时仍可见骨折线,下肢行走无异常,术后未发生感染或神经损伤等严重并发症。改良Harris评分由术前平均41.7±3.7改善至术后89.1±2.9。无假体松动或位置不当需要翻修的病例。影像学复查显示关节假体在位,金属臼杯、股骨假体与宿主骨嵌合良好,无明显松动。所有施行臼侧植骨及股骨截骨的患者植骨及截骨处均骨性愈合,无假体松动,活动度无明显受限,患髋无痛,Trendelenburg征阴性,均无须使用行走辅助工具。结论:对CroweⅣ型髋关节发育不良患者行全髋关节置换术时,良好的真臼暴露、加深髋臼、股骨短缩、斜行截骨及使用S-ROM组配式股骨柄假体假体能提高全髋关节置换术的治疗效果。     

High Hip Center Reduces the Dynamic Hip Range of Motion and Increases the Hip Load: A Gait Analysis Study in Hip Arthroplasty Patients With Unilateral Developmental Dysplasia

BackgroundLong-term favorable clinical outcomes of anatomical or high hip center techniques in total hip arthroplasty (THA) are reported in patients with developmental dysplasia of the hip (DDH). However, there is little information about the effect of the hip center location on gait characteristics. The purpose of this study was to compare these surgical techniques with gait analysis, analyze the effect of the hip rotation center location on gait parameters, and discuss the possible problems that may arise.MethodsA total of 40 patients who underwent THA due to unilateral coxarthrosis secondary to Crowe type III-IV DDH and completed 5 years of follow-up were included in the study. Group 1 included 20 patients who underwent anatomical hip center reconstruction, while group 2 included 20 patients who underwent high hip center reconstruction. Gait analysis was performed, and the groups were compared according to the gait characteristics.ResultsThe mean temporospatial values were similar between the groups. The extension of the operated side was significantly lower in group 2 (?9.11 ± 8.92) than in group 1 (?1.87 ± 11.51) (P = .04). The mean longitudinal hip joint force was found to be significantly higher in group 2 (8.92 N/kg ± 0.54) than in group 1 (8.16 N/kg ± 0.66) (P = .04). The high hip center technique has been shown to increase the load on the hip and restrict the dynamic range of motion.ConclusionThe high hip center technique can decrease the survival of the implant and increase the fall risk as it increases the load on the hip and reduces the dynamic range of motion. The hip center should be reconstructed anatomically when possible in DDH patients who undergo unilateral THA.     

Influence of Hip Geometry Reconstruction on Frontal Plane Hip and Knee Joint Moments During Walking Following Primary Total Hip Replacement

BackgroundFollowing total hip replacement (THR), hip geometry reconstruction parameters such as the femoral offset (FO) correlate with hip stability and wear. The purpose of this study is to determine the relationship between hip geometry parameters and knee and hip joint loading during walking.MethodsForty-one patients were examined before and a minimum of 1 year after primary THR. Pearson correlation coefficient (r) was performed to identify relationships between radiographic parameters and gait data. In addition, we divided patients into 2 groups according to the restoration of the FO (within ±5 mm vs more than 5 mm increment).ResultsThe FO and global offset (GO) showed a positive correlation with the first (r = 0.469, P = .002; r = 0.542, P < .001) and second (r = 0.365, P = .019; r = 0.484, P = .001) knee adduction moment (KAM). The neck-shaft angle revealed a negative correlation with the first hip adduction moment (r = ?0.375, P = .047). The reconstruction of FO with an increment of more than 5 mm was associated with a significant higher first KAM (+16%, P = .045) compared to the restored group.ConclusionOur findings suggest that abnormal hip and knee joint loading during walking after THR have a biomechanical background originating from hip geometry reconstruction. Patients with a high FO/GO were more likely to have an increased KAM during walking or vice versa. Surgeons need to be aware that an accurate control of FO, GO, and neck-shaft angle restoration in THR has an impact on hip and knee joint loading that may influence degenerative changes of the knee and higher wear of the artificial hip joint, respectively.     

人工全髋关节置换术治疗强直性脊柱炎髋关节病变的临床疗效

目的 观察人工全髋关节置换治疗强直性脊柱炎髋关节病变的手术方法和临床效果.方法 对2001年3月至2009年6月26例(31髋)强直性脊柱炎髋关节病变患者行人工全髋关节置换并随访,置换前患者日常活动均明显受限或者严重疼痛,Harris评分平均(43.2±5.8)分,髋关节活动度平均51.8°±9.7°.记录术后末次随访的Harris评分,X线检查结果,观察假体有无松动、脱位及异位骨化. 结果 所有病例得到随访,平均随访24.9(8 ～125)个月.末次随访患者均疼痛消失,步态正常.Harris评分平均(82.4±4.7)分;髋关节活动度平均148.6°±7.4°;髋关节Harris评分及关节活动度均显著高于置换前(P＜0.05).2髋出现异位骨化,为Brooker分级Ⅰ、Ⅲ级.无脱位、骨折及假体松动下沉,无患者进行翻修. 结论 人工全髋关节置换是治疗强直性脊柱炎晚期髋关节病变的有效方法,可以恢复关节功能,缓解关节疼痛并改善患者生活质量.     

Prior Hip Arthroscopy Increases Risk for Perioperative Total Hip Arthroplasty Complications: A Matched-Controlled Study

BackgroundArthroscopic hip surgery is becoming increasingly popular for the treatment of femoroacetabular impingement and labral tears. Reports of outcomes of hip arthroscopy converted to total hip arthroplasty (THA) have been limited by small sample sizes. The purpose of this study was to investigate the impact of prior hip arthroscopy on THA complications.MethodsWe queried our institutional database from January 2005 and December 2017 and identified 95 hip arthroscopy conversion THAs. A control cohort of 95 primary THA patients was matched by age, gender, and American Society of Anesthesiologists score. Patients were excluded if they had undergone open surgery on the ipsilateral hip. Intraoperative complications, estimated blood loss, operative time, postoperative complications, and need for revision were analyzed. Two separate analyses were performed. The first being intraoperative and immediate postoperative complications through 90-day follow-up and a second separate subanalysis of long-term outcomes on patients with minimum 2-year follow-up.ResultsAverage time from hip arthroscopy to THA was 29 months (range 2-153). Compared with primary THA controls, conversion patients had longer OR times (122 vs 103 minutes, P = .003). Conversion patients had a higher risk of any intraoperative complication (P = .043) and any postoperative complication (P = .007), with a higher rate of wound complications seen in conversion patients. There was not an increased risk of transfusion (P = .360), infection (P = 1.000), or periprosthetic fracture between groups (P = .150). When comparing THA approaches independent of primary or conversion surgery, there was no difference in intraoperative or postoperative complications (P = .500 and P = .790, respectively).ConclusionConversion of prior hip arthroscopy to THA, compared with primary THA, resulted in increased surgical times and increased intraoperative and postoperative complications. Patients should be counseled about the potential increased risks associated with conversion THA after prior hip arthroscopy.     

合并症对股骨颈骨折人工全髋关节置换术后髋关节功能的影响

目的 探讨何种合并症对股骨颈骨折人工全髋关节置换术（total hip arthroplasty,THA）术后髋关节功能及死亡率有影响;美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级和Charlson合并症指数（Charlson Comorbidity Index,CCI）是否是术后髋关节功能水平降低及死亡率升高的危险因素。方法 纳入2020年1月至2022年1月于苏州大学附属张家港医院就诊并接受THA的175例老年股骨颈骨折病人,年龄为65~86岁,其中男42例,女133例,收集包括合并症在内的临床资料,术后12个月随访使用Harris髋关节评分（Harris Hip Score,HHS）评价髋关节功能并进行回顾性分析。采用Logistic回归分析术后12个月髋关节功能不良和死亡事件发生的危险因素。结果 脑血管疾病［OR=6.917,95% CI（2.983,16.023）,P＜0.001］、痴呆［OR=11.531,95% CI（1.774,74.963）,P=0.010］、中重度肾功能不全［OR=12.629,95% CI（2.998,53.197）,P=0.001］、肿瘤（不伴转移）［OR=63.118,95% CI（5.419,734.360）,P=0.001］、ASA分级［OR=25.305,95% CI（3.337,191.905）,P=0.002］和CCI［OR=12.367,95% CI（1.876,81.451）,P=0.009］为术后12个月髋关节功能不良的危险因素;心肌梗死［OR=52.985,95% CI（3.575,785.248）,P=0.004］、帕金森病［OR=58.850,95% CI（5.618,616.464）,P=0.001］以及ASA分级［OR=16.643,95% CI（2.264,122.486）,P=0.006］是术后12个月死亡的危险因素。结论 在股骨颈骨折THA术后髋关节功能恢复方面,脑血管疾病、痴呆、中重度肾功能不全和肿瘤是需要被特别关注的合并症;为降低术后12个月死亡率,应对合并心肌梗死和帕金森病的病人加强护理、支持和合并症治疗。此外,CCI和ASA分级在THA术后髋关节功能评估方面有一定的临床意义,ASA分级同样可以用于术后死亡率的评估。     

Relieved Low Back Pain after Total Hip Arthroplasty in Patients with Both Hip Osteoarthritis and Lumbar Degenerative Disease

ObjectiveTo investigate the relief of low back pain after hip arthroplasty in patients with hip joint and spinal degenerative diseases, and to discuss the effects of unilateral and bilateral hip surgery on the relief of low back pain.MethodsIn this retrospective study, we followed 153 patients (69 males and 84 females, age: 43–88 years) who had undergone total hip arthroplasty (THA) via a posterolateral approach and also suffered from lumbar degenerative diseases in the period of 2009 to 2019. The inclusion criteria were: (i) patients who had been diagnosed with severe hip degenerative disease and also been diagnosed with lumbar degenerative disease; (ii) patients who had undergone THA surgery; and (iii) patients who were retrospectively recruited. The exclusion criteria were: (i) patients who had undergone lumbar fusion or internal fixation surgery; or (ii) patients who had vascular claudication, history of major trauma, diabetic polyneuropathy, lumbar and pelvic infections, tumor diseases; (iii) or patients who had undergone THA because of femoral neck fracture or ankylosing spondylitis. The improvement of hip joint function and the relief of low back pain (LBP) were studied, and the effect of unilateral and bilateral THA on the relief of LBP were discussed. Hip pain and function were evaluated by the Harris Hip Score (HHS), LBP was evaluated by Visual Analog Scale (VAS), and lumbar function was evaluated by the Japanese Orthopaedic Association (JOA) scoring system.ResultsThe average follow‐up time was 44.3 months (24–108 months). All patients recovered smoothly without complications. The LBP VAS of 153 patients decreased from 4.13 ± 1.37 preoperatively to 1.90 ± 1.44 postoperatively. The average HHS increased from 45.33 ± 13.23 preoperatively to 86.44 ± 7.59 postoperatively at the latest follow‐up. According to Japanese Orthopaedic Association scoring system, the proportion of patients with good response to treatment in these 153 patients reached 93.46%. LBP VAS decreased from 4.18 ± 1.38 preoperatively to 1.95 ± 1.49 postoperatively in unilateral group and from 3.94 ± 1.32 preoperatively to 1.73 ± 1.23 postoperatively in bilateral group, respectively. There were only nine patients with persistent or aggravated LBP after operation. Among them, six patients underwent subsequent lumbar surgery (five patients had pain relieved after reoperation and one patient had not) and the other three patients chose conservative treatment for pain.ConclusionTHA can relieve LBP while relieving hip pain and restoring hip function in patients with both hip and lumbar degenerative disease, thus possibly avoiding further spinal surgery.     

Total Hip Arthroplasty in Rapidly Destructive Osteoarthritis of the Hip: A Case Series

Rapidly destructive osteoarthritis (RDO) of the hip is a rare condition characterized by rapid joint degeneration and destruction similar to findings of infection, osteonecrosis, or Charcot disease but without a definitive diagnosis. The cause and natural history of RDO are unclear, but total hip arthroplasty has been utilized as a treatment modality due to the severity of the symptoms. We reviewed retrospectively the records of total hip arthroplasties performed between 1990 and 2003 and identified ten hips in eight patients who fit the profile of the diagnosis of RDO. The mean age at time of surgery was 70. Nine hips were treated with total hip arthroplasty with a hybrid configuration; one hip was treated with a non-cemented total hip arthroplasty. Average follow-up was 6 years with no radiographic evidence of acetabular loosening or osteolysis and no evidence of asymmetric cup wear. One femoral component had evidence of loosening but has not been revised. RDO is an idiopathic condition with no single diagnostic laboratory, pathological, or radiographic finding. A complete preoperative work-up for other causes of hip disease prior to arthroplasty for suspected RDO is necessary to rule out treatable disease. Our series of patients with RDO responded well to hybrid and non-cemented total hip arthroplasty with good clinical and radiographic results.     

全髋表面置换术治疗强直性脊柱炎

目的：研究金属对金属全髋表面置换术治疗强直脊柱炎性髋关节病的近期疗效,探讨该病行全髋表面置换术的适应证和技术要点。方法：对2006年2月至2008年4月11例（15髋）行全髋表面置换术的强直性脊柱炎性髋关节病患者进行随访,男9例,女2例;年龄16～53岁,平均32．5岁。对手术前后关节疼痛、活动度、畸形矫正、松动及功能的改善进行对比研究,根据Harris评分系统进行比较,分析强直性脊柱炎患者行全髋表面置换术的可行性和技术难点。结果：失访1例,实际得访10例（14髋）,10例疼痛缓解：随访时间平均16．2个月（8-34个月）。术前Harris评分平均（30．9±3．4）分（2-47分）,术后16个月平均（85．1±3．1）分（46-94分）;术前屈髋度0°-75°,术后16个月35°～105°;术前外展度0°-30°,术后16个月15°～55°。评价：优10髋,良3髋,差1髋。9例术后生活自理,其中6例可奔跑。1例疼痛部分缓解,关节功能恢。复差。无术后股骨颈骨折发生,无异位骨化。结论：经过适当患。者选择,全髋表面置换术治疗强直性脊柱炎性髋关节病可以获得满意的疗效,术中的精细操作和个体化手术设计至关重要。     

Declining Revision Burden of Metal-on-Metal Hip Arthroplasties

BackgroundAdverse reactions to metal debris (ARMD) have been a problem with metal-on-metal (MoM) hip systems for a decade. Unacceptably high revision rates have been described for both stemmed MoM total hip arthroplasties (THAs) and hip resurfacings. The aim of this study was to report survivorship and temporal trends of hip revisions in patients with MoM hips.MethodsWe identified 2520 patients with 3013 MoM hip arthroplasties performed at our institution. These included 1532 primary stemmed MoM THAs, 1262 MoM hip resurfacings, and 219 stemmed MoM THAs implanted in revision surgery.ResultsRevision surgery was performed on 551 (36%) primary stemmed MoM THAs and on 179 (14%) resurfacings. The most common reason for revision was ARMD both among primary MoM THAs (83%) and hip resurfacings (70%). The 15-year implant survivorship was 69% (95% confidence interval [CI] 67-71%) for the whole study group, 56% (CI 53-60%) for stemmed primary MoM THAs, and 84% (CI 82-87%) for hip resurfacings. Clear temporal peak in the number of revisions for ARMD was seen in 2011-2013, and the trend has been decreasing since.ConclusionAfter a decade since outburst of the ARMD problematics with MoM hips, a large proportion of them have gone through revision surgery at our single high-volume center. The peak years were 2011-2013, and thereafter, the number of ARMD revisions has decreased every year. With the threshold for revision remaining constant at our institution, it is not likely that large amount of new cases of ARMD will be seen. As these results are derived from a single center's data, similar studies from other institutions are needed to see whether our results represent a global trend.     

Validation of a Risk Calculator for Conversion of Hip Arthroscopy to Total Hip Arthroplasty in a Consecutive Series of 1400 Patients

BackgroundA previously published calculator used age, preoperative modified Harris Hip Score, femoral anteversion, preoperative lateral center-edge angle, revision surgery, and acetabular and femoral cartilage damage to provide risk estimates for conversion rate of hip arthroscopy to total hip arthroplasty (THA). Validation for this calculator has not been established. The purpose of this study is to (1) validate the previously published hazard ratios for the predictor factors in a new cohort of hip arthroscopies with minimum 2-year follow-up and (2) determine the accuracy of the calculator at determining conversion rates to THA at 2 and 4 years of follow-up.MethodsHazard ratios for THA conversion were calculated using data between February 2008 and November 2016 and compared to the previously published results, which comprised the training set. Actual conversion to THA data was used to evaluate the accuracy of the calculator.ResultsOf the 1400 patients examined, THA conversion occurred in 101 (7.2%) patients at an average of 28.4 ± 22.9 months (0.2-115.8) after hip arthroscopy. The hazard ratios for the validation set compared to the training set were as follows: age 1.06 versus 1.06; modified Harris Hip Score 0.97 versus 0.98; femoral anteversion 0.99 versus 0.97; lateral center-edge angle 0.98 versus 0.93; and revision surgery 1.77 versus 2.40. Accuracy of the risk calculator at 2 years was 75% (Harrell C-statistic 0.806) and at 4 years was 73% (C-statistic 0.797).ConclusionThis study found 75% and 73% accuracy at 2 and 4 years respectively in calculating risk of conversion of hip arthroscopy to THA using a previously published calculator. As this calculator relies on intraoperative data, the major benefit it provides is information regarding patient prognosis postoperatively. Furthermore, it could potentially enable the surgeon, after receiving proper surgical consent, to decide on immediate conversion to THA.Level of EvidenceIII, retrospective cohort.