初次全髋关节置换术后5年以上随访结果

目的对本组行初次全髋关节置换术（THA）5年以上的患者进行临床及影像学随访,探讨其疗效、并发症及其影响因素。方法对北京协和医院骨科2006年以前行THA并具有完整临床资料的248例（285髋）患者进行临床及影像学随访。截至末次随访时,174例（198髋）获得随访,随访率为70.2%,随访时间平均为7.6年（5.5~11.6年）。临床随访包括术前术后Harris评分及各种并发症。影像学评估包括双侧髋关节正位（或骨盆正位）、患髋侧位片,判断人工假体位置、假体周围骨质以及并发症情况。结果术前Harris评分平均为34.4分（0~86分）,末次随访时平均为88分（35~99分）,优良率为88.5%。术后假体总的生存率为97.1%。术后并发症包括跛行（9例）、异位骨化（8髋）、脱位（7例）、假体松动（2例）和感染（3例）等。结论本组病例整体疗效满意、假体生存期长,随访率偏低、病例数偏少,因此有待于进一步随访。     

初次全髋关节置换术中生物型股骨柄5年以上随访结果分析

目的评估生物型初次全髋关节置换术（THA）5年以上患者的临床疗效、影像学结果、并发症及其影响因素。方法对1995年1月至2006年6月期间接受生物型初次全髋关节置换术治疗髋部疾病的患者110例124髋进行随访。截至末次随访时,40例（44髋）患者获得随访,随访时间平均为8.2年（5~16.3年）。临床观察Harris评分、各种并发症,影像学评估假体位置、假体周围骨质以及并发症情况。假体生存率采用Kaplan-Meier方法进行分析,以无菌性松动所致翻修为随访终点。结果随访率为36.4%。Harris评分由术前为（48.47±14.54）分提高至末次随访时（91.37±5.44）分（P〈0.001）。截止随访终点,术后并发症包括脱位（1例1髋）、无菌性松动（2例2髋）、深静脉血栓（1例1髋）、异位骨化（13例13髋）,无感染。生物型股骨柄15年生存率为100%。结论初次THA术中生物型股骨假体的远期生存率令人满意,但需要提高随访率。     

初次骨水泥型人工全髋关节置换术的中远期疗效分析

目的回顾性分析初次骨水泥型全髋关节置换术（THA）的中远期临床及影像学疗效、假体的生存率及其相关影响因素。方法对1991年7月至2006年6月间接受初次骨水泥型THA的患者187例（201髋）进行随访。观察并发症情况、影像学表现,并对Harris评分和骨密度结果值进行统计学分析,以假体翻修为随访终点,计算假体的生存率。结果共117例（126髋）获得完整随访,平均随访时间为13.5年。Harris评分由术前的（32.8±22.5）分提高至末次随访时的（90.3±7.3）分,差异有统计学意义（t=-27.91,P〈0.01）。假体周围界面有不同表现的患者的骨密度结果比较无统计学差异（F=0.289,P〉0.05）。晚期感染1髋,脱位3髋,下肢深静脉血栓4髋,下肢不等长4髋,假体周围骨折2髋,异位骨化6髋,无菌性松动5髋。共有7髋接受髋关节翻修手术,平均翻修手术时间为初次置换术后11.3年,假体的生存率为94.4%。结论骨水泥型THA在治疗高龄骨质疏松患者髋关节疾病方面可以取得良好的临床效果,骨水泥假体的远期生存率令人满意。     

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。     

全髋关节置换术治疗成人髋关节发育不良继发骨关节炎五年以上随访研究

目的 评价全髋关节置换术(total hip arthroplasty,THA)在成人髋关节发育不良(develop-mental dysplasia of the hip,DDH)继发骨关节炎患者中的疗效,回顾性分析该类患者THA术后5年以上的临床疗效及其影响因素.方法 对2000年2月至2002年7月在我院采用THA治疗DDH继发骨关节炎的患者55例(69髋)进行术后随访.临床评估以Harris评分为标准.影像学评估根据随访骨盆平片及患髋正、侧位X线片,观察髋臼、股骨假体位置及其周围骨质变化,测量内衬磨损率.假体生存率采用Kaplan-Meier方法进行分析,以任何原因的臼杯、股骨柄翻修或影像学假体明显松动为随访终点.结果 截至随访终点,共45例(57)髋获得5年以上随访,平均随访时间69个月,随访率为81.8%.Harris评分由术前的(46.19±18.01)分提高至末次随访时的(91.78±3.52)分,尚无假体翻修病例.聚乙烯内衬平均磨损率为(0.27±0.14)mm/年.5髋髋臼侧发生骨溶解,8髋股骨侧近端发生骨溶解.Kaplan-Meier分析假体总生存率为1.0(95%可信区间,0.98～1.00).结论 THA治疗DDH继发骨关节炎5年以上随访的影像学表现及临床效果尚可,但存在较高的聚乙烯磨损率及骨溶解发生率,对于年轻、活动量大的DDH患者,THA手术时应选择新型耐摩擦界面假体.DDH患者的定期随访尤为重要,可甲期发现骨溶解,及时给予相应的治疗.     

比较人工全髋关节置换在治疗股骨头缺血性坏死和类风湿性关节炎中的作用

目的评估人工全髋关节置换（THA）在治疗股骨头缺血性坏死（AVN）和类风湿性关节炎（RA）中的作用。方法采用非骨水泥型THA治疗的42例（50髋）AVN和40例（50髋）RA患者,分别进行临床和影像学比较。临床随访包括Harris评分、术后翻修率和并发症分析;影像学评估包括骨溶解、聚乙烯臼杯磨损率分析。结果患者均获随访,时间5～10年。临床随访结果：AVN组和RA组Harris评分由术前（49.59±9.03）分和（48.76±7.61）分,术后分别提高到（90.76±5.64）分和（87.18±6.83）分,较术前均明显提高,但两组间Harris分值提高差异无统计学意义（P〉0.05）;AVN组和RA组术后翻修率分别为6%（3髋）和8%（4髋）,并发症分别为6%（3髋）和10%（5髋）,两组间差异无显著性（P〉0.05）。影像学结果：聚乙烯磨损率AVN组明显高于RA组,分别为（0.15±0.11）mm/年和（0.10±0.09）mm/年,两组比较差异有统计学意义（P〈0.05）;髋臼侧骨溶解发生率AVN组明显高于RA组,分别为18%（9髋）和4%（2髋）,两组比较差异有统计学意义（P〈0.05）;而股骨侧假体骨溶解发生率分别为20%和12%,两组比较差异无统计学意义（P〉0.05）。结论非骨水泥型THA在AVN和RA随访中均取得了良好的疗效,但AVN组髋臼侧聚乙烯内衬磨损和髋臼骨溶解高于RA组。     

陶瓷-陶瓷全髋关节置换术中期随访结果的报道

目的分析陶瓷-陶瓷全髋关节置换术（THA）平均5年随访的临床结果。方法延长随访先前报道2001年9月至2007年12月本组进行的1139例（1208髋）陶瓷-陶瓷THA,包括Stryker陶瓷-陶瓷全髋关节354例（368髋）,普鲁士陶瓷-陶瓷全髋关节672例（727髋）,Lima陶瓷-陶瓷全髋关节（三明治型）113例（113髋）。其中,男617例,女522例,平均年龄59.5岁（39~75岁）。术前诊断包括股骨头缺血性坏死334例,发育性髋关节发育不全238例,骨性关节炎335例,强直性脊柱炎84例,类风湿性关节炎87例,股骨颈骨折GardenⅣ型61例。至2011年3月,共有1017例病例获得随访。结果以翻修为终点的假体生存率为98.5%,并发症包括脱位11例,其中3例因为反复脱位而翻修;假体周围骨折5例,其中3例因假体松动而进行翻修;感染7例,均行二期翻修;陶瓷碎裂3例,2例进行了翻修,1例仍在随访中;异响3例,均未需要翻修。末次随访,平均术后Harris髋关节评分92.4分。在没有翻修的病例中,没有发现骨溶解的证据。结论陶瓷-陶瓷THA平均5年的中期临床结果满意。     

单一颈长假体对国人全髋置换术后下肢长度的影响

背景：全髋关节置换术（THA）后肢体不等长是常见并发症,国内外已大量研究涉及如何均衡下肢长度,但针对单一股骨颈长设计的假体是否匹配国人髋关节生理特点,术中如何调整以及长期随访情况仍值得深入研究。目的：探讨Corail柄单一颈长假体对国人THA后双下肢长度的影响,及其长期临床疗效。方法：1999年11月至2001年3月选用Corail柄假体行THA患者50例（57髋）,临床评估采用Harris髋关节评分及相关并发症分析。影像学评估根据术后及随访时的X线片观察股骨假体的位置及其周围的骨质改变。假体生存率采用Kaplan-Meier分析,分别以股骨柄的无菌性松动和任何原因所致的股骨柄翻修为终点。结果：50例（57髋）获得随访,随访时间为10.1~11.8年,平均（10.7±5.3）年。患者初次手术时年龄36~81岁,平均（61.8±10.6）岁,身高141~177 cm,平均（162.1±9.5）cm,小转子上保留截骨长度2~10 mm,平均（5.3±1.7）mm。术前Harris评分为19~63分,平均（40.8±12.6）分,末次随访时为81~97分,平均（89.9±4.4）分。初始X线片示Corail柄与髓腔的匹配度100%满意,内翻和外翻固定分别有1髋,其余均为中心固定。至终末随访时,除4例（4髋）影像学上表现为稳定的纤维长入,其余均表现为稳定的骨长入。27髋（43.4%）可见假体柄与骨界面间的点焊现象;13髋（22.8%）在柄的远端有骨性基座形成。应力遮挡性骨吸收：EnghⅠ度57髋（100%）,Ⅱ度41髋（71.9%）。9例患者在股骨大转子区发现局灶性骨溶解征象,其中1例面积较大者手术治疗。截止末次随访时无一例股骨柄翻修或影像学表现为无菌性松动,股骨柄十年生存率为100%。结论：使用Corail柄单一颈长假体时适当增加股骨颈截骨更符合国人体型较小、股骨颈较短的生理特点,可以获得良好的长期固定和临床效果。     

陶瓷全髋关节置换治疗中青年髋关节疾病的中长期疗效

目的探讨陶瓷-陶瓷全髋关节置换术(total hip arthroplasty,THA)治疗中青年髋关节疾病患者的中长期疗效。方法 1999年5月至2005年5月,共65例(83髋)中青年患者因髋关节疾病在我科采用陶瓷-陶瓷THA治疗且随访资料完整,男44例(54髋),女21例(29髋);手术时年龄21~45岁,平均(36.5±11.9)岁。记录手术前后Harris评分、术后脱位、骨溶解、异响及陶瓷碎裂等。结果所有患者均获随访,随访时间11~17年,平均(13.4±4.1)年。Harris评分由术前32~57分,平均(48.8±8.9)分,提高到末次随访时56~100分,平均(96.3±16.4)分,P0.05;随访中1髋(1.2%)患者发生后脱位、2髋(2.4%)出现关节异响、1髋(1.2%)出现陶瓷内衬碎裂、无一例假体松动及假体周围骨溶解。结论中青年患者髋关节疾病采用陶瓷-陶瓷THA治疗,中长期临床疗效满意。     

初次全髋关节置换术后6年以上随访的临床疗效分析

目的评价初次全髋关节置换（THA）术后6年以上的临床疗效及术后的各种并发症。方法自2001年1月至2005年1月,本中心共对北京地区210例225侧髋关节进行初次THA。其中单侧髋关节置换术195例,双髋同时置换术15例。半髋置换10例,全髋关节置换术215例。骨水泥固定假体18例,非骨水泥固定假体207例。围手术期及术后处理基本一致。术后定期随访,最新的随访时间平均为6.5年（5.5~8.5年）。结果围手术期并发症包括：术中股骨干骨折6例;下肢深静脉血栓28例,无肺栓塞病例;术后伤口感染4例;术后4周内脱位3例;术后出现一过性意识障碍3例。术后平均6.5年时176例183髋得到随访,34例42髋失访。远期感染病例1例,脱位2例,股骨干骨折4例。Harris评分由术前平均40.6分（-12~59分）提高到术后平均80.4分（75~94分）。其中152例评分〉80分,19例评分位于70~80分之间,5例评分〈70分。影像学检查3例髋臼假体、4例6髋股骨假体周围出现小范围的透亮线,2例3髋发现位于髋关节周围的异位骨化。其余X线片示髋臼和股骨柄假体位置满意,无松动和感染征象。结论 THA是治疗各种晚期重度髋关节疾病很好的方法,6年以上的临床效果良好,并发症少。     

Third-Generation Ceramic-on-Ceramic Bearing Surfaces in Revision Total Hip Arthroplasty

With an increase of revision total hip arthroplasty (THA), the choice of bearing surface becomes more important. Wear debris by conventional metal-on-polyethylene articulations may cause extensive osteolysis, especially in young patients. We analyzed the clinical and radiographic outcomes after revision THA using third-generation ceramic-on-ceramic bearing surfaces in 42 hips. The mean age of the patients was 48.8 years (32-59 years), and the mean duration of follow-up monitoring was 5.4 years (3.2-8.0 years). At final follow-up examination, the average Harris Hip Score was 91.3. Although minor complications were observed in 6 hips (14.3%), no hips required additional revision surgery. No hip showed radiolucent lines, acetabular cup migration, or osteolysis. Our data show that clinical and radiographic outcomes after revision THA using third-generation ceramic-on-ceramic bearing surfaces are favorable. Ceramic-on-ceramic bearing surfaces can be preferentially considered for revision THA, especially in young patients. Further studies with long-term follow-up data are warranted.     

Total hip arthroplasty after failed transtrochanteric rotational osteotomy for avascular necrosis of the femoral head

We compared the clinical and radiographic outcome of 15 hips converted to total hip arthroplasty after failed transtrochanteric rotational osteotomy (THA after TRO) for avascular necrosis of the femoral head (ANFH) with that of a matched control group of 16 hips with primary THA for ANFH. The operating time in THA after TRO was significantly longer than that in primary THA. Perioperative blood loss in THA after TRO was significantly more than that in primary THA. Postoperative complications were observed in 4 hips of THA after TRO. The Harris Hip Score, the stability of implants, and survival rates did not significantly differ in both groups. We conclude that TRO did not influence the outcome of secondary THA at short- and middle-term follow-up.     

Revision of Failed Metal-on-Metal Total Hip Arthroplasty: Midterm Outcomes of 203 Consecutive Cases

BackgroundMetal-on-metal (MoM) revisions have shown high rates of complications from aseptic loosening, deep infection, and dislocation. The purpose of this study is to report on outcomes and complications of a large consecutive series of patients who were revised for failed MoM total hip arthroplasty (THA).MethodsWe evaluated 188 patients (203 hips) who underwent revisions of failed MoM THA. Mean age at the revision was 60 years old. Gender was female in 112 hips (55%) and male in 91 hips (45%). Mean interval to failure after primary THA was 4.9 years (range, 0-18 years). The acetabular component was revised in 183 cases (92%). Clinical outcomes assessed included pain score and Harris hip score.ResultsMean follow-up from revision was 4.2 years. Harris hip score improved from 53.6 pre-revision to 73.5 at most recent follow-up (P < .001). Pain level significantly improved from 17.2 pre-revision to 32.8 post-revision (P < .001). Reoperations occurred in 28 (14%) hips. Re-revision was required in 16 hips (7.9%). The most common reasons for re-revision were aseptic loosening (5), dislocation (3), infection (2), and iliopsoas tendonitis (2). Re-revision was significantly higher in cases of pseudotumor. There was no difference in survival with ultraporous cups. Three hips required re-revision to custom triflange components. All-cause survival was 90.5% at 4.2 years. Metal ion levels significantly declined after revision.ConclusionRevisions of failed MoM THA showed improvements in clinical outcomes, but present significant surgical challenges and complications especially in cases with soft tissue damage and pseudotumor.     

Total Hip Arthroplasty in Patients With Osteogenesis Imperfecta

BackgroundOsteogenesis imperfecta (OI) comprises a spectrum of disorders that result in bone fragility. This presents unique challenges when performing total joint arthroplasty in patients with OI. The purpose of this study is to determine the survivorship and clinical outcomes of total hip arthroplasty (THA) in patients with OI.MethodsWe retrospectively reviewed our institution’s total joint registry from 1969 to 2018 for all primary THAs in patients with a history of OI. There were 11 patients (13 hips) with a mean follow-up of 13 years (range 6-20). Survivorship free of component revision was determined using Kaplan-Meier analysis. Patient-reported clinical outcomes were assessed using Harris Hip Scores.ResultsAt final follow-up, the status of the implant was known in all 13 hips. One patient (1 hip) was deceased. Four hips (31%) underwent revision surgery at a mean of 9 years (range 5-17). Survivorship free of component revision was 52% at 20 years. Mean Harris Hip Scores at final follow-up were fair (75, 47-97), but significantly improved compared to available preoperative scores (P = .0015). No intraoperative complications occurred during the 13 primary THAs.ConclusionTHA in patients with OI is associated with high revision rates and low survivorship at long-term follow-up. Although this is a very challenging patient population, THA provided these patients with improved functional outcomes. To the authors’ knowledge, this is the largest series of primary THA in patients with OI reported in the literature and therefore provides surgeons with important data regarding the expected outcomes following THA in this unique patient population.Level of EvidenceLevel IV.     

A Modified S-ROM Stem in Primary Total Hip Arthroplasty for Developmental Dysplasia of the Hip

This study examined the clinical outcome of 220 hips in 196 Asian patients who underwent primary total hip arthroplasty (THA) for treatment of developmental dysplasia of the hip (DDH) using a modified S-ROM modular (S-ROM-A) stem designed for Asians, after 2–5 years (mean, 3.3 years) of follow-up. The stem was placed so that the anteversion angle of the neck was decreased against the sleeve in 56% of the hips and increased in 18% of the hips. Bone ingrown fixation was achieved in 99.5% of the hips on X-ray at final follow-up. There were 2 (0.9%) dislocations postoperatively. In primary THA for treatment of DDH accompanied by femoral rotational deformity, the freely-rotatable modular stem provided favorable short-term outcomes by affording both morphological and functional advantages.     

A Reliable Femoral Osteotomy in Total Hip Arthroplasty for Hartofilakidis Type C Developmental Dysplasia of the Hip: Proximal Femoral Reconstruction

BackgroundProcedure of the femur is extremely challenging during total hip arthroplasty (THA) for Hartofilakidis type C developmental dysplasia of the hip. The main purpose of this study is to compare the clinical effectiveness of proximal femoral reconstruction (PFR) with subtrochanteric transverse osteotomy (STO).MethodsBetween 2006 and 2015, 33 primary THAs in 26 patients were performed with PFR and 16 hips in 13 patients underwent STO. The mean follow-up was 4.2 (range, 2.2-10.8) years in PFR group and 5.9 (range, 3.5-11.3) years in STO group. At the final follow-up, clinical scores and radiographic results were evaluated for 33 hips in PFR group and 15 hips in STO group.ResultsPostoperative Harris hip scores and implant position did not differ between the treatment groups. The mean length of the oblique osteotomy line at proximal femur was 6.9 cm (range, 5.8-7.6 cm) in PFR group. The amount of bone union occurred within 6 months after surgery was 24 (72.7%) hips in PFR group and 9 (60.0%) in STO group. Three major postoperative complications occurred in PFR group, and medial femoral calcar erosion was noted in 1 hip in STO group.ConclusionSimilar with STO, the clinical results of PFR technique are a reliable solution for femoral procedure during THA in patients with Hartofilakidis type C developmental dysplasia of the hip.     

Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients

Background  The number of hemodialysis patients has progressively increased in Japan. Among the orthopedic complications in this population, chronic hip arthropathy associated with long-term hemodialysis is one of the most devastating problems. Total hip arthroplasty (THA) is often indicated. However, varying results have been reported for THA in these patients. This study was undertaken to assess the risk-benefit ratio of THA performed in patients with dialysis hip arthropathy. Methods  We evaluated 17 patients (19 hips) with dialysis hip arthropathy who underwent THA. The duration of hemodialysis before surgery ranged from 10 to 27 years. Histological examination of the tissue samples revealed accumulation of amyloid deposits in all cases. Three patients died within 2 years after operation; the remaining 14 patients (16 hips) were followed for a minimum of 3 years. Results  The cumulative survival rate of the prostheses in these 16 hips up to the latest follow-up was 94%. Regarding surgery-related complications, deep infection occurred in one hip, and revision THA was required in one patient with recurrent dislocation and aseptic loosening. Conclusions  THA for dialysis hip arthropathy in long-term hemodialysis patients is associated with substantial local and general risks. Despite the substantial risk, THA for this patient population seems to afford reasonably satisfactory results.