Abdulkarim Ali, Keegan Cathy, Bajwa Raazi, Sheehan Eoin
Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford, Ireland.
Royal College of Surgeons in Ireland, Dublin 2, Ireland.
Ir J Med Sci. 2018 Aug;187(3):663-668. doi: 10.1007/s11845-017-1701-1. Epub 2018 Jan 15.
Lateral trochanteric pain (LTP) complicates up to 17% of cases of total hip arthroplasty (THA). Studies have refuted underlying trochanteric bursitis. Restoration of the femoral offset and reproduction of the natural femoral centre of rotation are important in successful arthroplasty. LTP is believed to be associated with their alteration.
The aim of our study was to evaluate the effect of femoral offset and centre of rotation on the incidence of LTP post-THA.
A retrospective case control study was developed from 158 patients who underwent a THA over a two-year period to form two patient cohorts. Twenty-nine patients diagnosed with LTP were matched with 110 control subjects. The direct lateral approach was used in all cases. Anterior-posterior pelvic radiographs before and after surgery were compared to assess the femoral, cup and global offsets and limb length discrepancies between the two groups. Statistical analyses were performed using the Mann-Whitney U test and independent samples t test.
Twenty-nine diagnosed with post-operative LTP. Sixty-two percent of symptomatic patients were female (p = 0.13). The median ages were 74.33 (symptomatic) and 70.71 (control) (p = 0.11). The differences (pre-post) of the femoral (p = 0.17), cup (p = 0.5) and global offsets (p = 0.99) and mean of limb length discrepancy (LLD) (p = 0.83) were not significant between the two groups.
No relationship was found between LTP and femoral offset or femoral centre of rotation. Disruption of the soft tissues during a lateral approach with resultant abductor tear, tendon defects and tendinitis might play a role in LTP and explain the apparent efficacy of corticosteroid injections.
转子外侧疼痛（LTP）在全髋关节置换术（THA）病例中发生率高达17%。已有研究驳斥了潜在的转子滑囊炎。在成功的关节置换术中，恢复股骨偏心距和重现天然股骨旋转中心很重要。LTP被认为与这些改变有关。
我们研究的目的是评估股骨偏心距和旋转中心对THA后LTP发生率的影响。
对158例在两年内接受THA的患者进行回顾性病例对照研究，以形成两个患者队列。29例被诊断为LTP的患者与110例对照受试者进行匹配。所有病例均采用直接外侧入路。比较手术前后的骨盆前后位X线片，以评估两组之间的股骨、髋臼杯和整体偏心距以及肢体长度差异。使用Mann-Whitney U检验和独立样本t检验进行统计分析。
29例被诊断为术后LTP。62%的有症状患者为女性（p = 0.13）。中位年龄分别为74.33岁（有症状组）和70.71岁（对照组）（p = 0.11）。两组之间股骨（p = 0.17）、髋臼杯（p = 0.5）和整体偏心距（p = 0.99）的差异（术前-术后）以及肢体长度差异（LLD）均值（p = 0.83）均无统计学意义。
未发现LTP与股骨偏心距或股骨旋转中心之间存在关联。外侧入路期间软组织的破坏导致外展肌撕裂、肌腱缺损和肌腱炎可能在LTP中起作用，并解释了皮质类固醇注射的明显疗效。
