Jauregui Julio J, Kim Joseph K, Shield William P, Harb Matthew, Illical Emmanuel M, Adib Farshad, Maheshwari Aditya V
Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA.
Int Orthop. 2017 Aug;41(8):1535-1542. doi: 10.1007/s00264-017-3436-z. Epub 2017 Mar 27.
Patients with surgically or spontaneously fused hips are often dissatisfied with their overall function and the debilitating effect on adjacent joints. Therefore, in properly selected patients, hip fusion-takedown and conversion to total hip arthroplasty (THA) can result in improved function and decreased pain. We aimed to (1) evaluate the indications for conversion, (2) evaluate the clinical outcomes, (3) analyze the overall complications, and (4) identify the overall satisfaction following the procedure.
A systematic and comprehensive literature search was performed to analyze studies evaluating conversion of hip fusion to THA. After reviewing 3,882 studies, 27 total studies (1,104 hips) met our inclusion/exclusion criteria and were included in our final analysis. A weighted mean of rates was determined for each complication, including infection, instability, loosening, nerve-related, abductor-related, venous thrombotic event, and revision.
The study population consisted of 53.2% male and 46.8% female subjects. The mean age at time of conversion was 52 years (range 36-65 years), the mean time until follow-up was 9.2 years (range 2.5-17.3), and the mean duration of arthrodesis was 27.7 years (range 11-40.2). As measured by Harris Hip Score, overall clinical outcomes improved from 58.1 points (range 42.4-70 points) pre-operatively to 80.0 (range 62-93.5) post-operatively. The specific complication rates were 5.3% (range 0-43.6%) for infection, 2.6% (range 0-15.4%) for instability, 6.2% (range 0-17.2%) for loosening, 4.7% (range 0-13%) for nerve-related complications, 13.1% (range 0-87%) for abductor-related complications, and 1.2% (range 0-13%) for venous thrombotic events. The revision rate was 12.0% (range 0-43.6%).
Takedown of a fused-hip can be a challenging procedure. Although patients can benefit functionally, both patients and surgeons need to be aware of the complications and increased risk of further revision procedures, which should be an important part of the pre-operative discussion.
接受手术融合或自发融合髋关节的患者通常对其整体功能以及对相邻关节的致残影响不满意。因此，对于经过适当选择的患者，拆除髋关节融合并转换为全髋关节置换术（THA）可改善功能并减轻疼痛。我们旨在（1）评估转换的适应症，（2）评估临床结果，（3）分析总体并发症，以及（4）确定该手术后的总体满意度。
进行了系统而全面的文献检索，以分析评估髋关节融合转换为THA的研究。在查阅了3882项研究后，共有27项研究（1104例髋关节）符合我们的纳入/排除标准，并纳入了我们的最终分析。确定了每种并发症发生率的加权平均值，包括感染、不稳定、松动、神经相关、外展肌相关、静脉血栓形成事件和翻修。
研究人群中男性占53.2%，女性占46.8%。转换时的平均年龄为52岁（范围36 - 65岁），平均随访时间为9.2年（范围2.5 - 17.3年），关节固定术的平均持续时间为27.7年（范围11 - 40.2年）。根据Harris髋关节评分，总体临床结果从术前的58.1分（范围42.4 - 70分）提高到术后的80.0分（范围62 - 93.5分）。具体并发症发生率为：感染5.3%（范围0 - 43.6%），不稳定2.6%（范围0 - 15.4%），松动6.2%（范围0 - 17.2%），神经相关并发症4.7%（范围0 - 13%），外展肌相关并发症13.1%（范围0 - 87%），静脉血栓形成事件1.2%（范围0 - 13%）。翻修率为12.0%（范围0 - 43.6%）。
拆除融合的髋关节可能是一项具有挑战性的手术。尽管患者在功能上可以受益，但患者和外科医生都需要意识到并发症以及进一步翻修手术风险的增加，这应该是术前讨论的重要组成部分。
