1st Department of Hip and Knee Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy.
Arch Orthop Trauma Surg. 2012 Aug;132(8):1133-9. doi: 10.1007/s00402-012-1538-z. Epub 2012 May 10.
Total hip replacement has been advocated for the treatment of degenerative hip diseases secondary to slipped capital femoral epiphysis; nonetheless, outcomes of this procedure have not been well established. We reviewed the outcomes of modern total hip replacements in patients who suffered from slipped capital femoral epiphysis.
A retrospective study was carried out on 32 total hip replacements performed on 28 patients who suffered from slipped capital femoral epiphysis from August 1994 to January 2007. The average age at the time of surgery was 45 years. Clinical evaluation was performed using the Harris Hip Score, radiographic assessment measuring cup and stem orientation, the extent of osteolysis around the implant, and leg length discrepancy. The average follow-up was 98 months (range 25-204 months).
Two total hip replacements failed, one for stem aseptic loosening and the other for modular neck failure. The cumulative survival rate at 9 years was 92.8 %. If the end point was revision for implant loosening, the survival rate improved to 96.8 % at 9 years. The only complication recorded was an intraoperative fracture of the lesser trochanter immediately treated with cerclage wire. At the latest follow-up, the Harris Hip Score averaged 86 (range 70-97). Leg length discrepancies greater than 1 cm were present in 18 cases before surgery, and in only 6 cases after surgery.
We recommend total hip replacement for patients who suffer from slipped capital femoral epiphysis because of the satisfactory survival, low complication rate, and the possibility of restoring leg length.
全髋关节置换术已被提倡用于治疗因股骨头骨骺滑脱而继发的退行性髋部疾病；然而，该手术的效果尚未得到充分证实。我们回顾了因股骨头骨骺滑脱而行全髋关节置换术的患者的治疗效果。
我们对 1994 年 8 月至 2007 年 1 月期间因股骨头骨骺滑脱而行全髋关节置换术的 28 例患者的 32 例髋关节进行了回顾性研究。手术时的平均年龄为 45 岁。采用 Harris 髋关节评分进行临床评估，测量髋臼杯和柄的位置、假体周围骨溶解的程度以及肢体长度差异。平均随访时间为 98 个月（范围 25-204 个月）。
有 2 例全髋关节置换术失败，其中 1 例因柄无菌性松动，另 1 例因组合式颈部失败。9 年的累积生存率为 92.8%。如果以翻修为假体松动的终点，9 年的生存率提高至 96.8%。仅记录到 1 例术中小转子骨折，立即用环扎钢丝进行了治疗。在末次随访时，Harris 髋关节评分为 86 分（范围 70-97 分）。术前肢体长度差异大于 1cm 的有 18 例，术后仅 6 例。
我们建议对因股骨头骨骺滑脱而就诊的患者行全髋关节置换术，因为该手术具有较高的生存率、较低的并发症发生率，并且有可能恢复肢体长度。
