Grosso Matthew J, Danoff Jonathan R, Thacher Ryan, Murtaugh Taylor S, Hickernell Thomas R, Shah Roshan P, Macaulay William
Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York - USA.
NYU Langone Orthopedic Hospital, New York - USA.
Hip Int. 2017 Oct 16:0. doi: 10.5301/hipint.5000547.
The purpose of this study was to determine risk factors for conversion to total hip arthroplasty (THA) in patients originally treated with hemiarthroplasty (HA) for displaced femoral neck fractures.
In this case-controlled study, we identified 54 patients who were treated with HA for femoral neck fracture (FNF) who subsequently underwent conversion to THA at our institution between 2003 and 2013. We randomly selected 142 control patients who underwent HA for a displaced FNF without conversion surgery during the same time period. We compared demographic data, implant parameters, and radiographic data between the groups to identify risk factors for conversion surgery.
In the univariate analysis, younger age at index surgery (mean 75 vs. 80 years, p = 0.006), higher body mass index (26.1 vs. 23.7, p = 0.031), bipolar prosthesis (20% vs. 36%, p = 0.024), absence of dementia (6% vs. 23%, p = 0.01), increased leg length compared to contralateral limb (6.5 mm vs. 0.2 mm, p<0.001), and increased HA femoral head size compared to the contralateral femoral head (2.7 mm vs. 1.5 mm, p = 0.02) were associated with a significantly increased risk of conversion surgery. In the multivariate logistic regression, decreased age at index surgery, no dementia, use of a bipolar head, and increased leg length discrepancy (LLD) were associated with risk of conversion.
Patient characteristics, including younger age, increased BMI, and absence of dementia can lead to increased risk for conversion of HA to THA. Intraoperative considerations of head size and increase in ipsilateral LLD may increase the risk of conversion surgery. These factors should be considered by surgeons who employ HA for displaced FNFs.
本研究的目的是确定最初接受半髋关节置换术（HA）治疗的移位型股骨颈骨折患者转为全髋关节置换术（THA）的危险因素。
在这项病例对照研究中，我们确定了54例接受HA治疗股骨颈骨折（FNF）的患者，这些患者于2003年至2013年期间在我们机构随后接受了转为THA的手术。我们随机选择了142例对照患者，他们在同一时期接受HA治疗移位型FNF且未进行转换手术。我们比较了两组之间的人口统计学数据、植入物参数和影像学数据，以确定转换手术的危险因素。
在单因素分析中，初次手术时年龄较小（平均75岁对80岁，p = 0.006）、体重指数较高（26.1对23.7, p = 0.031）、使用双极假体（20%对36%，p = 0.024）、无痴呆（6%对23%，p = 0.01）、与对侧肢体相比腿长增加（6.5毫米对0.2毫米，p<0.001）以及与对侧股骨头相比HA股骨头尺寸增加（2.7毫米对1.5毫米，p = 0.02）与转换手术风险显著增加相关。在多因素逻辑回归分析中，初次手术时年龄降低、无痴呆、使用双极股骨头以及腿长差异（LLD）增加与转换风险相关。
患者特征，包括年龄较小、BMI增加和无痴呆，可导致HA转为THA的风险增加。术中对股骨头尺寸的考虑以及同侧LLD增加可能会增加转换手术的风险。采用HA治疗移位型FNF的外科医生应考虑这些因素。
