Karimi Dennis, Kallemose Thomas, Troelsen Anders, Klit Jakob
Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, Hvidovre, 2650, Copenhagen, Denmark.
Arch Orthop Trauma Surg. 2018 Apr;138(4):581-589. doi: 10.1007/s00402-018-2900-6. Epub 2018 Feb 10.
In Denmark, 20% of all registered total hip arthroplasties (THA) from 1995 to 2014 has been patients younger than 60 years with primary idiopathic osteoarthritis (OA). It is speculated that hip malformations may be a major contributor to early OA development. It has been shown that hip malformation may compromise implant position and, therefore, identifying and knowing the incidence of malformations is important. Our aim was to assess the prevalence and type of hip malformations in a cohort of younger patients undergoing THA.
In this prospective two center cohort study, 95 consecutive patients (106 hips) met the inclusion criteria. One observer performed radiographic measurements for malformations and radiographic OA. Inter- and intraobserver variability was assessed.
From 95 patients (male n = 52 and female n = 43) age ranged from 35 to 59 years and prevalences of hip malformations were; CAM-deformity 50.9 and 25.5%, coxa profunda 33 and 27.4%, acetabular retroversion 33 and 29.2%, and acetabular dysplasia 10.4 and 3.8%. All patients showed minimum of one malformation. Prevalences of Tönnis grade 0-1 were 22.6% and 2-3 were 77.4%.
All patients showed malformations, especially high prevalences were found for CAM-deformity, coxa profunda and acetabular retroversion. Identifying these malformations is fairly simple and recognizing the high prevalence may help surgeons avoid pitfalls during implant positioning in THA surgery. Further, focus on hip malformations may facilitate correct referral to joint-preserving surgery before OA develops.
在丹麦，1995年至2014年期间所有登记的全髋关节置换术（THA）患者中，有20%为60岁以下的原发性特发性骨关节炎（OA）患者。据推测，髋关节畸形可能是早期OA发展的主要因素。研究表明，髋关节畸形可能会影响植入物的位置，因此，识别并了解畸形的发生率很重要。我们的目的是评估接受THA的年轻患者队列中髋关节畸形的患病率和类型。
在这项前瞻性双中心队列研究中，95例连续患者（106髋）符合纳入标准。一名观察者对畸形和影像学OA进行了放射学测量。评估了观察者间和观察者内的变异性。
95例患者（男性n = 52，女性n = 43）年龄在35至59岁之间，髋关节畸形的患病率分别为：凸轮畸形50.9%和25.5%，髋臼过深33%和27.4%，髋臼后倾33%和29.2%，髋臼发育不良10.4%和3.8%。所有患者至少有一处畸形。Tönnis分级0 - 1级的患病率为22.6%，2 - 3级为77.4%。
所有患者均有畸形，尤其是凸轮畸形、髋臼过深和髋臼后倾的患病率较高。识别这些畸形相当简单，认识到高患病率可能有助于外科医生在THA手术中避免植入物定位时的陷阱。此外，关注髋关节畸形可能有助于在OA发展之前正确转诊至保关节手术。
