te Stroet Martijn A J, Ghisai Sushma A, Keurentjes J Christiaan, Rijnen Wim H C, Gardeniers Jean W M, Van Kampen Albert, Schreurs B Willem
Department of Orthopaedics, Radboud University Medical Center, Nijmegen, The Netherlands,
Int Orthop. 2015 Sep;39(9):1723-30. doi: 10.1007/s00264-015-2722-x. Epub 2015 Apr 12.
It is often a difficult decision whether it is safe to perform revision hip surgery in a patient of 80 years and older. Therefore we evaluated the results of cemented revisions in these elderly patients.
Clinical data, radiographs and complications of 49 consecutive cup and/or stem revisions in 48 patients were prospectively collected. The average age of the patients at surgery was 84 years (range, 80-92). We performed Kaplan-Meier (KM) analysis and also a competing risk (CR) analysis because in this series the presence of a competing event (i.e. death) prevents the occurrence of endpoint rerevision.
Twenty-nine patients (30 hips) died without rerevision during follow-up and their data was included. The average follow-up of the 16 surviving patients was eight years (range, six to 13). Six re-operations were performed, of which three were re-revisions. Eight-year survivorship was 91.6% (95% confidence interval (CI) 76-97%) for endpoint re-revision for any reason. With the CR analysis we calculated that due to the increasing number of competing events, the KM analysis overestimates the failure rate with 32% for this endpoint. The average Harris hip score improved from 49 to 74. Mortality within three months after surgery was 6%. One postoperative fracture occurred and six hips dislocated.
Cemented revisions can provide satisfying results in patient of 80 years and older with acceptable survivorship and complication rates.
对于80岁及以上的患者进行髋关节翻修手术是否安全，往往是一个艰难的决定。因此，我们评估了这些老年患者进行骨水泥固定翻修手术的结果。
前瞻性收集了48例患者连续49次髋臼和/或股骨柄翻修手术的临床资料、X线片及并发症情况。患者手术时的平均年龄为84岁（范围80 - 92岁）。我们进行了Kaplan-Meier（KM）分析以及竞争风险（CR）分析，因为在本系列研究中，存在竞争事件（即死亡）会阻止终点翻修事件的发生。
29例患者（30髋）在随访期间未进行翻修手术死亡，其数据被纳入分析。16例存活患者的平均随访时间为8年（范围6至13年）。共进行了6次再次手术，其中3次为再次翻修。因任何原因进行终点再次翻修的8年生存率为91.6%（95%置信区间（CI）76 - 97%）。通过CR分析我们计算得出，由于竞争事件数量增加，KM分析对于该终点的失败率高估了32%。Harris髋关节平均评分从49分提高到74分。术后3个月内的死亡率为6%。发生了1例术后骨折，6髋发生脱位。
骨水泥固定翻修手术可为80岁及以上患者提供令人满意的结果，生存率和并发症发生率均可接受。
