Thillemann Theis M, Pedersen Alma B, Johnsen Søren P, Søballe Kjeld
Departments of Orthopedics, Aarhus University Hospital, Aarhus, Denmark.
Acta Orthop. 2008 Dec;79(6):769-76. doi: 10.1080/17453670810016830.
Childhood hip disorders including acetabular dysplasia, congenital hip dislocation, epiphysiolysis, and morbus Calve-Legg-Perthes are well-established risk factors for the development of early osteoarthritis of the hip. These patients have an increased risk of undergoing a total hip arthroplasty (THA) operation early in their life. However, there are very few data on implant survival in such patients.
We used data from the Danish Hip Arthroplasty Registry to identify patients who had been treated with a primary THA in Denmark between 1995 and 2005. Implant survival during early and late postoperative follow-up (< 6 months and>6 months, respectively) was assessed for patients treated with a primary THA due to childhood hip disorders, and compared with implant survival for THA patients with primary osteoarthritis.
56,087 THA procedures included 53,694 (96%) hips with primary osteoarthritis, 890 (1.6%) with acetabular dysplasia, 565 (1.0%) with congenital hip dislocation, 267 (0.5%) with epiphysiolysis, and 404 (0.7%) hips with morbus Calve-Legg-Perthes Patients with acetabular dysplasia had an increased risk of revision during the 0-6-month postoperative period compared to patients with primary osteoarthritis (adjusted relative risk (RR)=1.9 (95% CI: 1.2-3.1)). These revisions were mainly performed due to dislocation of the THA, providing an adjusted RR of revision due to dislocation of 2.8 (95% CI: 1.6-4.9) compared to patients operated due to primary osteoarthritis. We found no statistically significant differences in risk of revision for the other childhood hip disorder groups during the early postoperative phase. In addition, we found no substantial differences in revision risk during later follow-up (0.5-12 years) for any of the childhood hip disorders compared to patients with primary osteoarthritis.
We found an encouraging rate of long-term implant survival for patients with childhood hip disorders. The major concern is the increased risk of revision because of dislocation in the first 6 postoperative months for patients with acetabular dysplasia. However, the advent of alternative bearings and the use of large-diameter femoral heads may improve the outcome after primary THA in these patients.
儿童髋关节疾病，包括髋臼发育不良、先天性髋关节脱位、骨骺溶解以及佩特兹病，是公认的髋关节早期骨关节炎发生的危险因素。这些患者在其生命早期接受全髋关节置换术（THA）的风险增加。然而，关于此类患者植入物生存率的数据非常少。
我们使用丹麦髋关节置换登记处的数据，确定1995年至2005年期间在丹麦接受初次THA治疗的患者。对因儿童髋关节疾病接受初次THA治疗的患者在术后早期和晚期随访（分别为<6个月和>6个月）期间的植入物生存率进行评估，并与原发性骨关节炎THA患者的植入物生存率进行比较。
56,087例THA手术中，53,694例（96%）髋关节为原发性骨关节炎，890例（1.6%）为髋臼发育不良，565例（1.0%）为先天性髋关节脱位，267例（0.5%）为骨骺溶解，404例（0.7%）为佩特兹病。与原发性骨关节炎患者相比，髋臼发育不良患者在术后0 - 6个月期间翻修风险增加（调整后相对风险（RR）=1.9（95%CI：1.2 - 3.1））。这些翻修主要是由于THA脱位进行的，与因原发性骨关节炎手术的患者相比，因脱位导致翻修的调整后RR为2.8（95%CI：1.6 - 4.9）。我们发现其他儿童髋关节疾病组在术后早期翻修风险无统计学显著差异。此外，与原发性骨关节炎患者相比，我们发现在后期随访（0.5 - 12年）期间，任何儿童髋关节疾病的翻修风险均无实质性差异。
我们发现儿童髋关节疾病患者的长期植入物生存率令人鼓舞。主要问题是髋臼发育不良患者在术后头6个月因脱位导致翻修风险增加。然而，替代轴承的出现和大直径股骨头的使用可能会改善这些患者初次THA后的结局。
