Sedrakyan Art, Romero Lucas, Graves Stephen, Davidson David, de Steiger Richard, Lewis Peter, Solomon Michael, Vial Robyn, Lorimer Michelle
Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065.
Australian Orthopaedic Association National Joint Replacement Registry (S.G., D.D., P.L., and R.V.) and Data Management & Analysis Centre (M.L.), Discipline of Public Health, MDP DX 650 511, University of Adelaide, Adelaide, SA 5005, Australia.
J Bone Joint Surg Am. 2014 Dec 17;96 Suppl 1(Suppl 1):73-8. doi: 10.2106/JBJS.N.00541.
One of the least researched areas in orthopaedic pediatrics is the safety and effectiveness of joint replacement, in part because it is uncommon and is undertaken for a wide range of conditions not common for adult joint replacement. This study used data from the AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry) to analyze the use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the pediatric population and to provide preliminary data on the outcome of these procedures.
The AOANJRR, which is part of the ICOR (International Consortium of Orthopaedic Registries), provided information on pediatric procedures reported to the registry by hospitals undertaking arthroplasty procedures in Australia. All THA and TKA procedures reported to the registry from 1999 to 2012 were included. The cumulative percent revision and the hazard ratio from Cox proportional-hazards models were used for analysis. All tests were two-tailed, with a 5% level of significance. Additionally, an overview of the literature is presented to provide a point of reference.
Primary conventional THA was performed in 297 patients twenty years of age or younger; the cumulative percent revision at five years was 4.5%. Primary conventional THA was performed in 975 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 5.4%. Primary THA was performed in 105 patients twenty years of age or younger; the cumulative percent revision at five years was 4.6%. Primary TKA was performed in 159 young adults twenty-one to thirty years of age; the cumulative percent revision at five years was 10.3%.
Compared with older adults, pediatric patients and young adults undergoing THA and TKA have very different diagnoses, including a high prevalence of tumor. Although the reported rate of revision surgery is currently similar to that for older patients, the number of reported procedures and the follow-up period remain limited. It is important for registries to continue to collect and analyze data relevant to this cohort and to coordinate these activities in order to better understand the safety and effectiveness of joint arthroplasty in the pediatric population.
小儿骨科领域中研究最少的领域之一是关节置换的安全性和有效性，部分原因是该手术并不常见，且用于治疗一系列与成人关节置换不同的病症。本研究使用了澳大利亚骨科协会国家关节置换登记处（AOANJRR）的数据，分析全髋关节置换术（THA）和全膝关节置换术（TKA）在儿科人群中的使用情况，并提供这些手术结果的初步数据。
AOANJRR是国际骨科登记协会联盟（ICOR）的一部分，提供了澳大利亚进行关节置换手术的医院向该登记处报告的儿科手术信息。纳入了1999年至2012年期间向登记处报告的所有THA和TKA手术。使用Cox比例风险模型的累积翻修百分比和风险比进行分析。所有检验均为双侧检验，显著性水平为5%。此外，还提供了文献综述作为参考。
297名20岁及以下患者接受了初次传统THA；五年时的累积翻修百分比为4.5%。975名21至30岁的年轻成人接受了初次传统THA；五年时的累积翻修百分比为5.4%。105名20岁及以下患者接受了初次THA；五年时的累积翻修百分比为4.6%。159名21至30岁的年轻成人接受了初次TKA；五年时的累积翻修百分比为10.3%。
与老年人相比，接受THA和TKA的儿科患者和年轻成人的诊断差异很大，包括肿瘤患病率较高。尽管目前报告的翻修手术率与老年患者相似，但报告的手术数量和随访期仍然有限。登记处继续收集和分析与该队列相关的数据并协调这些活动，以更好地了解关节置换术在儿科人群中的安全性和有效性非常重要。
