Instituto de Cirugía Ortopédica y Traumatología de Barcelona, Río de Oro 37, 5º3ª, Barcelona 08034, Spain.
Clin Orthop Relat Res. 2011 Jul;469(7):1971-83. doi: 10.1007/s11999-010-1704-y. Epub 2010 Nov 30.
Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA.
QUESTIONS/PURPOSES: We compared THA after hip arthrodesis and primary THA to determine whether these procedures would be associated with similar functional scores, maintenance of scores with time, complications and failures, survivorship of the arthroplasty, and patient satisfaction.
We retrospectively matched 48 patients undergoing conversion of a fused hip to a THA between January 1980 and January 2000, with 50 patients receiving a primary THA during the same period. We prospectively followed all patients between January 2000 and January 2010. The changes in function and pain after THA were compared between the two cohorts using the Harris hip score (HHS) and the Rosser Index Matrix (RIM). The Oxford hip score (OHS) and the SF-36 also were used to assess quality of life (QOL) during followup. Complications were collected and survivorship of the THA was evaluated. Patient satisfaction was assessed using the Robertsson and Dunbar questionnaire. The minimum followup was 10 years (mean, 17 years; range, 10-29 years).
At last followup, hip function and health-related QOL were similar for patients having conversion of hip arthrodesis to THA and for patients having a routine THA. Scores diminished overall in the two groups between 2000 and 2010, but without a difference for the HHS, RIM QOL, and OHS in the study cohort. The rate of complications, THA survival, and patient satisfaction were similar in both groups.
Conversion of hip arthrodesis to a THA provides substantial improvement of hip function and health-related QOL, with an acceptable rate of complications, good expectancy of survival for the arthroplasty, and high level of patient satisfaction comparable to those of primary THA.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
髋关节融合术后转为全髋关节置换术（THA）是一种合理的解决方案，可改善功能，减轻背部和膝关节疼痛，并减缓与髋关节融合相关的邻近关节的退化。尽管移动范围、肌肉力量、下肢长度差异（LLD）、跛行持续时间和对助行器的需求通常比传统初次 THA 更差，但患者通常对转换感到满意。
问题/目的：我们比较了髋关节融合术后的 THA 和初次 THA，以确定这些手术是否与相似的功能评分、随时间推移评分的维持、并发症和失败、关节置换的存活率以及患者满意度相关。
我们回顾性匹配了 1980 年 1 月至 2000 年 1 月期间接受融合髋关节转为 THA 的 48 例患者，以及同期接受初次 THA 的 50 例患者。我们前瞻性随访了所有患者，随访时间为 2000 年 1 月至 2010 年 1 月。使用 Harris 髋关节评分（HHS）和 Rosser 指数矩阵（RIM）比较两组术后髋关节功能和疼痛的变化。在随访期间，还使用牛津髋关节评分（OHS）和 SF-36 评估生活质量（QOL）。收集并发症并评估 THA 的存活率。使用 Robertsson 和 Dunbar 问卷评估患者满意度。最低随访时间为 10 年（平均 17 年；范围，10-29 年）。
末次随访时，髋关节融合术后转为 THA 的患者和初次 THA 的患者髋关节功能和健康相关 QOL 相似。两组 HHS、RIM QOL 和 OHS 评分在 2000 年至 2010 年间均总体下降，但无差异。两组并发症发生率、THA 存活率和患者满意度相似。
髋关节融合术后转为 THA 可显著改善髋关节功能和健康相关 QOL，并发症发生率可接受，关节置换预期寿命良好，患者满意度与初次 THA 相当。
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
