Huber Joerg, Dieppe Paul, Dreinhoefer Karsten, Günther Klaus-Peter, Judge Andrew
1Department of Orthopedics, Stadtspital Triemli, Zurich, Switzerland 2University of Exeter Medical School, University of Exeter, Exeter, United Kingdom 3Centre of Musculoskeletal Surgery, Charité, University of Berlin, Berlin, Germany 4Department of Orthopaedics, Traumatology and Sports Medicine, Medical Park Berlin Humboldtmuehle, Berlin, Germany 5University Center of Orthopaedics and Traumatology, Gustav Carus University Medicine, Technical University Dresden, Dresden, Germany 6Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Headington, United Kingdom 7MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom.
J Bone Joint Surg Am. 2017 Sep 6;99(17):1428-1437. doi: 10.2106/JBJS.16.01040.
Although arthritis in other affected major joints and back pain are known to lead to worse outcomes following total hip replacement, to our knowledge, these risk factors have not previously been operationalized as a musculoskeletal morbidity profile. The aim of this study was to measure the influence of other major joints and the spine (as grades of musculoskeletal morbidity) on the 1-year outcome of primary total hip replacement.
The EUROHIP study consists of 1,327 patients undergoing primary total hip replacement for arthritis across 20 European orthopaedic centers. The primary outcome was the responder rate at 12 months calculated with the relative effect per patient for total hip replacement using the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The primary predictor of interest was different combinations of arthritis of major joints and the spine grouped into 4 musculoskeletal morbidity grades: 1 (single major joint), 2 (multiple major joints), 3 (single major joint and spine), and 4 (multiple major joints and spine). The confounders adjusted for were age, sex, body mass index, living situation, years of hip pain, American Society of Anesthesiologists (ASA) class, anxiety or depression, and preoperative WOMAC subscales.
For this analysis, 845 patients were included with complete 12-month follow-up WOMAC scores. The mean patient age was 65.7 years, and 55.2% of patients were female.
The involvement of other major joints and the spine assessed as 1 of 4 musculoskeletal morbidity grades had a strong influence on the 1-year outcome after total hip replacement. The effect size was large compared with other risk factors. Even so, the majority of patients in musculoskeletal morbidity grade 4 had favorable outcomes from the surgical procedure (>74% response to surgical procedures).
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
虽然已知其他受累主要关节的关节炎和背痛会导致全髋关节置换术后预后更差，但据我们所知，这些风险因素此前尚未被纳入肌肉骨骼疾病谱。本研究的目的是评估其他主要关节和脊柱（作为肌肉骨骼疾病分级）对初次全髋关节置换术1年预后的影响。
EUROHIP研究纳入了20个欧洲骨科中心的1327例因关节炎接受初次全髋关节置换术的患者。主要结局是使用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分计算的每位患者全髋关节置换术的相对疗效，以此得出12个月时的应答率。主要预测因素是主要关节和脊柱关节炎的不同组合，分为4个肌肉骨骼疾病等级：1级（单个主要关节）、2级（多个主要关节）、3级（单个主要关节和脊柱）和4级（多个主要关节和脊柱）。调整的混杂因素包括年龄、性别、体重指数、生活状况、髋关节疼痛年限、美国麻醉医师协会（ASA）分级、焦虑或抑郁以及术前WOMAC分量表。
本次分析纳入了845例有完整12个月随访WOMAC评分的患者。患者平均年龄为65.7岁，55.2%为女性。
作为4个肌肉骨骼疾病等级之一评估的其他主要关节和脊柱受累对全髋关节置换术后1年的预后有很大影响。与其他风险因素相比，效应量较大。即便如此，肌肉骨骼疾病4级的大多数患者手术预后良好（>74%对手术有反应）。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
Zotero 插件
