Kilgus D J, Amstutz H C, Wolgin M A, Dorey F J
Division of Orthopaedic Surgery, University of California, Los Angeles.
J Bone Joint Surg Am. 1990 Jan;72(1):45-54.
Forty-one fused hips in thirty-eight patients were converted to total hip replacement. The average length of follow-up was seven years. The predominant indications for conversion were progressively disabling pain in the low back or the hip, or both; loss of function due to immobility or malposition of the hip; and progressive pain and instability of the knee (usually ipsilateral). The postoperative arc of flexion averaged 87 degrees. Limb-length discrepancies improved an average of 2.5 centimeters. Postoperative function of the abductor muscles depended on the preoperative quality of those muscles and on the accuracy of the biomechanical restoration. Postoperative strength of the muscles of the hip improved for two years or more in most patients. There was complete or major relief of pain, improved mobility of the hip, and decreased dependence on supports for walking. There were nine failures: four because of sepsis, four because of loosening of the femoral component, and one because of malposition of the acetabular component. The failures were predominantly in patients who were fifty years old or less at the time of arthroplasty, patients who had had two or more previous operations, and patients who had had an injury to the hip. The quality of the results approached that after primary hip arthroplasty in older patients who have not had multiple previous operations on the hip. Survivorship analysis of the spontaneously fused hips that were treated with conventional hip replacement predicted a probability of survival of the implant of 96 per cent at thirteen years postoperatively (p = 0.048).
38例患者的41个融合髋关节被转换为全髋关节置换。平均随访时间为7年。转换的主要指征是下背部或髋关节或两者逐渐加重的致残性疼痛；由于髋关节固定不动或位置不当导致的功能丧失；以及膝关节（通常为同侧）逐渐加重的疼痛和不稳定。术后平均屈曲弧度为87度。肢体长度差异平均改善了2.5厘米。外展肌的术后功能取决于术前这些肌肉的质量以及生物力学恢复的准确性。大多数患者髋关节肌肉的术后力量改善持续两年或更长时间。疼痛完全或大部分缓解，髋关节活动度改善，行走对支撑物的依赖减少。有9例失败：4例因感染，4例因股骨部件松动，1例因髋臼部件位置不当。失败主要发生在关节置换时年龄在50岁及以下的患者、曾接受过两次或更多次先前手术的患者以及髋关节受过伤的患者中。在未对髋关节进行过多次先前手术的老年患者中，结果质量接近初次髋关节置换术后的质量。对接受传统髋关节置换治疗的自发融合髋关节进行的生存分析预测，术后13年植入物的存活概率为96%（p = 0.048）。
