Amanatullah Derek F, Trousdale Robert T, Sierra Rafael J
Orthopedics. 2015 May;38(5):e394-400. doi: 10.3928/01477447-20150504-56.
There are approximately 1.6 million lower extremity amputees in the United States. Lower extremity amputees are subject to increased physical demands proportional to their level of amputation. Lower extremity amputees have a 6-fold higher risk of developing radiographic osteoarthritis in the ipsilateral hip and a 2-fold risk of developing radiographic osteoarthritis in contralateral hip when compared with the non-amputee population. Additionally, there is a 3-fold increased risk of developing radiographic osteoarthritis in the ipsilateral hip after an above knee amputation when compared with a below knee amputation. The authors retrospectively reviewed 35 total hip arthroplasties after lower extremity amputation. The mean clinical follow-up was 5.3±4.0 years. The mean time from lower extremity amputation to total hip arthroplasty was 12.2±12.8 years after a contralateral amputation and 5.4±6.0 years after an ipsilateral amputation (P=.050). The mean time to total hip arthroplasty was 15.6±15.4 years after an above knee amputation and 6.4±6.1 years after a below knee amputation (P=.021). There was a statistically significant improvement in the mean Harris Hip Score from 35.9±21.8 to 76.8±12.8 with total hip arthroplasty after a contralateral amputation (P<.001). There also was a statistically significant improvement in the mean Harris Hip Score from 25.4±21.7 to 78.6±17.1 with total hip arthroplasty after an ispilateral amputation (P<.001). Three (17.7%) total hip arthroplasties after a contralateral amputation and 2 (11.1%) total hip arthroplasties after an ipsilateral amputation required revision total hip arthroplasty. Patients with an ipsilateral amputation or a below knee amputation progress to total hip arthroplasty faster than those with a contralateral amputation or an above knee amputation, respectively. Lower extremity amputees experience clinically significant improvements with total hip arthroplasty after lower extremity amputation.
美国约有160万下肢截肢者。下肢截肢者面临的身体需求增加，且与截肢程度成正比。与非截肢人群相比，下肢截肢者同侧髋关节发生影像学骨关节炎的风险高6倍，对侧髋关节发生影像学骨关节炎的风险高2倍。此外，与膝下截肢相比，膝上截肢后同侧髋关节发生影像学骨关节炎的风险增加3倍。作者回顾性分析了35例下肢截肢后的全髋关节置换术。平均临床随访时间为5.3±4.0年。对侧截肢后，从下肢截肢到全髋关节置换术的平均时间为12.2±12.8年；同侧截肢后为5.4±6.0年（P = 0.050）。膝上截肢后全髋关节置换术的平均时间为15.6±15.4年，膝下截肢后为6.4±6.1年（P = 0.021）。对侧截肢后行全髋关节置换术，Harris髋关节平均评分从35.9±21.8显著提高到76.8±12.8（P<0.001）。同侧截肢后行全髋关节置换术，Harris髋关节平均评分也从25.4±21.7显著提高到78.6±17.1（P<0.001）。对侧截肢后3例（17.7%）全髋关节置换术和同侧截肢后2例（11.1%）全髋关节置换术需要翻修全髋关节置换术。同侧截肢或膝下截肢的患者分别比有对侧截肢或膝上截肢的患者更快地进展为全髋关节置换术。下肢截肢者在下肢截肢后行全髋关节置换术可获得临床上显著的改善。
