Hayashi Shinya, Hashimoto Shingo, Takayama Koji, Matsumoto Tomoyuki, Nishida Kotaro, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Arthroplasty. 2017 May;32(5):1606-1611. doi: 10.1016/j.arth.2016.12.005. Epub 2016 Dec 14.
We identified preoperative predictors and size of acetabular bone defects for poor return to daily activity after revision total hip arthroplasty.
Our analysis was based on outcomes of 140 cases of revision total hip arthroplasty, performed for any reason between May 2001 and March 2013. The Japanese Orthopaedic Association (JOA) score and body mass index (BMI) measured preoperatively, and the University of California Los Angeles (UCLA) activity score and JOA score measured at the 2-year follow-up were evaluated. Acetabular bone defects were classified according to the American Academy of Orthopaedic Surgeons grading system, with further classification of the location and severity of each acetabular bone defect. We compared preoperative clinical factors and postoperative clinical outcomes statistically.
We found a significant association between the number of revision surgeries and worse postoperative JOA scores and UCLA activity scores. There were significant differences in postoperative JOA scores and UCLA activity scores between patients with partial and global acetabular bone defects.
Multiple revision surgeries and the size of the acetabular bone defect were predictors of both poorer clinical outcome and greater restriction in postoperative daily activities. Closer attention to the postoperative management of patients with a lower preoperative status is warranted.
我们确定了翻修全髋关节置换术后日常活动恢复不佳的髋臼骨缺损术前预测因素及大小。
我们的分析基于2001年5月至2013年3月间因任何原因进行的140例翻修全髋关节置换术的结果。评估术前测量的日本骨科协会(JOA)评分和体重指数(BMI),以及2年随访时测量的加州大学洛杉矶分校(UCLA)活动评分和JOA评分。髋臼骨缺损根据美国骨科医师学会分级系统进行分类,并对每个髋臼骨缺损的位置和严重程度进行进一步分类。我们对术前临床因素和术后临床结果进行了统计学比较。
我们发现翻修手术次数与术后较差的JOA评分和UCLA活动评分之间存在显著关联。部分和整体髋臼骨缺损患者术后的JOA评分和UCLA活动评分存在显著差异。
多次翻修手术和髋臼骨缺损大小是临床结果较差和术后日常活动受限更大的预测因素。有必要更加关注术前状态较差患者的术后管理。