Bradley Benjamin M, Moul Stephen J, Doyle Fintan J, Wilson Matthew J
Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom.
Blackrock Clinic, Dublin, Ireland.
J Arthroplasty. 2017 Mar;32(3):898-902. doi: 10.1016/j.arth.2016.09.019. Epub 2016 Sep 28.
Total hip arthroplasty is increasingly performed in younger, more active patients. Thirty-five percent of patients are involved in sports preoperatively, and a desire to return to sporting activity is now a major expectation. Sporting activity potentially risks premature failure of the implant, and there is no consensus or guidelines among British or European surgeons performing total hip arthroplasty in sporting patients.
The current practice of British Hip Society members was explored through a Web-based survey. Of the 260 members surveyed, 109 responded.
The majority of respondents (33%) would perform uncemented, 29.1% would perform hybrid, 15.5% would perform fully cemented, and 11.7% would perform a resurfacing hip arthroplasty for sporting patients. The preferred approach is the standard posterior (68.9%) and preferred bearing couples are ceramic-on-ceramic (39.8%) and ceramic-on-polyethylene (36.9%). Half of respondents would opt for a femoral head smaller than 36 mm, whereas 22.3% would use a head 36 mm or larger. A third would allow patients to return to sports between 6 and 12 weeks after surgery, whereas 43.7% advise patients to wait until 3 months postoperatively. All respondents allow patients to return to low-impact activities, but significant caution is exercised with regard to taking part in high-impact activities.
We report the practice of a specialist group of hip surgeons, the majority of which consider themselves young adult hip specialists. We believe that these data may be of use to help inform the practice of our colleagues when performing arthroplasty in sporting patients and may serve to inform future consensus guidelines.
全髋关节置换术越来越多地应用于更年轻、活动量更大的患者。35%的患者术前参与体育运动,如今恢复体育活动的愿望已成为一项主要期望。体育活动可能会使植入物过早失效,而在英国或欧洲为从事体育活动的患者实施全髋关节置换术的外科医生之间,对于这一问题尚无共识或指导方针。
通过一项基于网络的调查,探究英国髋关节协会成员的当前做法。在接受调查的260名成员中,109人作出了回应。
大多数受访者(33%)会为从事体育活动的患者实施非骨水泥型全髋关节置换术,29.1%会实施混合型,15.5%会实施全骨水泥型,11.7%会实施表面置换髋关节成形术。首选的手术入路是标准后路(68.9%),首选的关节面配对是陶瓷对陶瓷(39.8%)和陶瓷对聚乙烯(36.9%)。一半的受访者会选择直径小于36毫米的股骨头,而22.3%会使用直径36毫米或更大的股骨头。三分之一的受访者会允许患者在术后6至12周恢复运动,而43.7%建议患者等到术后3个月。所有受访者都允许患者恢复低强度活动,但对于参加高强度活动则非常谨慎。
我们报告了一组髋关节外科专家的做法,其中大多数人认为自己是年轻成人髋关节专家。我们相信,这些数据可能有助于为我们的同事在为从事体育活动的患者实施关节置换术时提供参考,并可能为未来的共识性指导方针提供依据。