Kim Seung-Chan, Lim Young-Wook, Jo Woo-Lam, Park Dong-Chul, Lee Jin-Woo, Kang Won-Woo, Kim Yong-Sik
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Banpodae-ro 222, Seocho-gu, Seoul, 137-701, South Korea.
BMC Musculoskelet Disord. 2017 Jun 17;18(1):266. doi: 10.1186/s12891-017-1605-2.
The optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months.
A total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group.
The mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery.
We suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.
对于需要双侧髋关节置换的患者，最佳手术方案仍存在争议。本研究的目的是比较同期双侧全髋关节置换术（THA）与分期双侧THA（两次手术间隔<12个月）的手术准确性、功能结局和健康相关生活质量，以及假体相关并发症和翻修手术情况。
对123例连续入选的患者（平均年龄43.3岁）进行回顾性研究，这些患者因股骨头坏死（ONFH）接受了双侧THA，且至少随访两年（平均60.2个月）；63例同期手术作为试验组，60例分期手术作为对照组。
同期组术后平均下肢长度差异（LLD）及LLD>3 mm的患者百分比显著更低（分别为P<0.001和P=0.001）。同期组还发现，第二次手术髋关节中位于安全区内的髋臼杯数量更多、矫正率更高且髋臼杯置入失败率更低。在最近一次随访时，同期组的平均Harris髋关节评分、欧洲五维健康量表指数和欧洲五维健康量表视觉模拟评分均更好（所有比较中P<0.001）。我们发现，同期手术与术后假体相关并发症和翻修手术的发生率较低相关。
我们建议，双侧ONFH可采用同期THA而非分期THA进行治疗，以获得更好的手术效果。
