Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Arthroplasty. 2017 Oct;32(10):3088-3092. doi: 10.1016/j.arth.2017.05.020. Epub 2017 May 18.
The objective of the present study was to investigate clinical, quality of life, and radiographic outcomes of patients who underwent total hip arthroplasty (THA) after transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH).
We performed a case-control study. The participants were 29 patients (34 hips) who underwent THA after TRO (TRO group). These patients had a mean age at surgery of 51.6 years (range, 30-72 years) and underwent postoperative follow-up for a mean period of 10.5 years (range, 3-19 years). For the control group (primary group), we included 58 patients (68 hips) who underwent primary THA for ONFH, matching for age and gender.
The Harris Hip Scores at the last follow-up were significantly poorer in the TRO group than in the primary group. Similarly, preoperative and postoperative hip range of motion was significantly poorer in the TRO group than in the primary group. Quality of life (Short Form-36, Oxford Hip Score, and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) and complication rates were not significantly different between the groups. The survival rates at 10 years, with revision for any reason as the endpoint, were 81% in the TRO group and 91% in the primary group, showing no significant difference between the groups. The TRO group had a larger average postoperative leg length discrepancy and a higher rate of stem malalignment than the primary group.
The clinical outcomes of THA after TRO for ONFH were poorer than those of primary THA.
本研究的目的是探讨股骨颈骨折（ONFH）患者行转子间旋转截骨（TRO）后行全髋关节置换术（THA）的临床、生活质量和影像学结果。
我们进行了一项病例对照研究。参与者为 29 例（34 髋）接受 TRO 后行 THA 的患者（TRO 组）。这些患者的手术平均年龄为 51.6 岁（范围 30-72 岁），术后平均随访 10.5 年（范围 3-19 年）。对于对照组（原发性组），我们纳入了 58 例（68 髋）因 ONFH 行初次 THA 的患者，年龄和性别相匹配。
最后一次随访时，TRO 组的 Harris 髋关节评分明显低于原发性组。同样，TRO 组术前和术后髋关节活动范围明显小于原发性组。两组间生活质量（SF-36、Oxford 髋关节评分和日本矫形协会髋关节疾病评估问卷）和并发症发生率无显著差异。以任何原因翻修为终点的 10 年生存率，TRO 组为 81%，原发性组为 91%，两组间无显著差异。TRO 组术后平均下肢长度差异较大，且骨干对线不良率高于原发性组。
TRO 治疗 ONFH 后行 THA 的临床结果劣于初次 THA。
