Utsunomiya Takeshi, Motomura Goro, Ikemura Satoshi, Hamai Satoshi, Fukushi Jun-Ichi, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Arthroplasty. 2017 Sep;32(9):2768-2773. doi: 10.1016/j.arth.2017.04.034. Epub 2017 Apr 27.
Since Sugioka transtrochanteric anterior rotational osteotomy (ARO) for osteonecrosis of the femoral head (ONFH) changes the morphology of the proximal femur, total hip arthroplasty (THA) after previous ARO is considered a technically demanding procedure. The purpose of this study was to compare the clinicoradiologic outcomes of THA after ARO with those of THA without any antecedent surgery for ONFH.
Twenty-four hips in 20 patients who underwent cementless THA after ARO (postosteotomy group) were retrospectively reviewed and compared with patients who underwent cementless THA without any antecedent surgery for ONFH during the same period (primary group). In the postosteotomy group, the mean duration from ARO to THA was 19.7 years. All patients were followed for at least 5 years (mean, 8.3 years; follow-up rate, 78.5%). A clinical assessment was performed preoperatively and at the latest follow-up using the Harris Hip Score. A radiographic examination was performed at 3 months after THA and at the latest follow-up.
The Harris Hip Score at the latest follow-up in the postosteotomy group was equivalent to that in the primary group, but longer operation time and greater intraoperative blood loss were observed in the postosteotomy group. There were no significant differences in postoperative complications, including dislocation (2 hips in each group). The leg lengthening in the postosteotomy group tended to be longer. No hips showed implant malpositioning, loosening, or required any revision surgery.
The clinicoradiologic outcomes of THA after ARO are considered to be comparable with those of THA without any antecedent surgery for ONFH.
由于用于股骨头坏死（ONFH）的杉冈转子间前旋转截骨术（ARO）会改变股骨近端的形态，因此既往接受过 ARO 后的全髋关节置换术（THA）被认为是一项技术要求较高的手术。本研究的目的是比较 ARO 后 THA 与未接受过任何 ONFH 前期手术的 THA 的临床和影像学结果。
回顾性分析 20 例接受 ARO 后非骨水泥型 THA 的患者的 24 个髋关节（截骨术后组），并与同期接受非骨水泥型 THA 且未接受过任何 ONFH 前期手术的患者（初次手术组）进行比较。在截骨术后组中，从 ARO 到 THA 的平均时间为 19.7 年。所有患者均随访至少 5 年（平均 8.3 年；随访率 78.5%）。术前和最新一次随访时使用 Harris 髋关节评分进行临床评估。THA 后 3 个月和最新一次随访时进行影像学检查。
截骨术后组最新一次随访时的 Harris 髋关节评分与初次手术组相当，但截骨术后组的手术时间更长，术中失血量更大。术后并发症，包括脱位（每组 2 髋）无显著差异。截骨术后组的肢体延长倾向于更长。没有髋关节出现植入物位置不当、松动或需要任何翻修手术。
ARO 后 THA 的临床和影像学结果被认为与未接受过任何 ONFH 前期手术的 THA 相当。
