Lee Sun-Ho, Lee Gun-Woo, Seol Young-Jun, Park Kyung-Soon, Yoon Taek-Rim
Department of Orthopedic Surgery, Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
Clin Orthop Surg. 2017 Sep;9(3):263-269. doi: 10.4055/cios.2017.9.3.263. Epub 2017 Aug 4.
The objective of this study was to compare clinical and radiological outcomes of total hip arthroplasty (THA) between ankylosing spondylitis (AS) of the hip joint and avascular necrosis (AVN) of the femoral head.
Thirty patients (30 hips) underwent cementless THA for AS between 2003 and 2012. They were compared to 30 patients (30 hips) who underwent the same procedure for AVN of the femoral head. Each group was matched for age and gender, and both groups had similar preoperative demographic characteristics. All cases were followed for minimum 4 postoperative years. Clinical evaluation was based on operation time, intraoperative blood loss, quantity of postoperative drainage, Harris Hip Score (HHS), and range of motion (ROM). Radiological results were evaluated by acetabular cup anteversion and inclination, femoral stem orientation, pre- and postoperative leg length discrepancy, and postoperative complications.
The operation time was significantly longer in the AS group (120.2 ± 26.2 min) than in the AVN group (79.5 ± 11.1 min). The volume of postoperative drainage was significantly greater in the AS group (764.5 ± 355.4 mL vs. 510.5 ± 195.6 mL). Preoperative HHS was lower in the AS group (55.6 ± 13.8 vs. 59.2 ± 2.8). Similarly, postoperative HHS was significantly lower in the AS group (92.8 ± 2.7 vs. 97.4 ± 2.6). The arc of ROM was improved from 146.5° ± 13.2° preoperatively to 254.7° ± 17.2° postoperatively in the AS group and from 182.6° ± 15.5° to 260.4° ± 13.7° in the AVN group. Implant position and postoperative leg length discrepancy were not different between the groups. However, three cases of heterotopic ossification was observed in the AS group, whereas only 1 case was found in the AVN group. One deep infection and one aseptic stem loosening were found in the AS group, whereas none was observed in the AVN group.
Cementless THA showed satisfactory clinical and radiological results in both groups, despite the longer operation time, larger blood loss volume, and lower HHS score of the AS group. Our findings suggest that cementless THA is an effective and reliable treatment for both AS and AVN.
本研究的目的是比较髋关节强直性脊柱炎（AS）和股骨头缺血性坏死（AVN）患者行全髋关节置换术（THA）后的临床和影像学结果。
2003年至2012年期间，30例（30髋）AS患者接受了非骨水泥型THA。将他们与30例因股骨头AVN接受相同手术的患者进行比较。每组在年龄和性别上进行匹配，两组术前人口统计学特征相似。所有病例术后至少随访4年。临床评估基于手术时间、术中出血量、术后引流量、Harris髋关节评分（HHS）和活动范围（ROM）。通过髋臼杯前倾和倾斜度、股骨柄方向、术前和术后肢体长度差异以及术后并发症评估影像学结果。
AS组的手术时间（120.2±26.2分钟）显著长于AVN组（79.5±11.1分钟）。AS组的术后引流量显著更大（764.5±355.4毫升对510.5±195.6毫升）。AS组术前HHS较低（55.6±13.8对59.2±2.8）。同样，AS组术后HHS显著较低（92.8±2.7对97.4±2.6）。AS组ROM弧度从术前的146.5°±13.2°改善至术后的254.7°±17.2°，AVN组从182.6°±15.5°改善至260.4°±13.7°。两组之间的植入物位置和术后肢体长度差异无差异。然而，AS组观察到3例异位骨化，而AVN组仅发现1例。AS组发现1例深部感染和1例无菌性柄松动，而AVN组未观察到。
尽管AS组手术时间较长、失血量较大且HHS评分较低，但非骨水泥型THA在两组中均显示出令人满意的临床和影像学结果。我们的研究结果表明，非骨水泥型THA是治疗AS和AVN的有效且可靠的方法。
