Kobayashi Seneki, Kubo Toshikazu, Iwamoto Yukihide, Fukushima Wakaba, Sugano Nobuhiko
The Japanese Investigation Committee on Osteonecrosis of the Femoral Head under the Ministry of Health, Labour and Welfare of Japan, Chiyoda, Tokyo, Japan.
Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa-city, Nagano-prefecture, Japan.
Int Orthop. 2018 Jul;42(7):1661-1668. doi: 10.1007/s00264-018-3980-1. Epub 2018 May 12.
To identify modifiable factors related to post-operative dislocation and reoperation in patients with osteonecrosis of the femoral head (ONFH) in a large cohort.
We studied 4995 hip arthroplasties: total hip arthroplasty (THA) was performed in 79% of patients; bipolar hemiarthroplasty (BP), 17%; total resurfacing arthroplasty (tRS), 3%; and hemi-resurfacing arthroplasty (hRS), 1%. A new type of BP (accounting for 49% of BPs) comprised a femoral component with a polished or smooth, small-diameter (approximately 10 mm) neck with a round or oval axial cut surface and no sharp corners.
The infection rate was relatively low (0.56%) even though 58% of cases of ONFH were associated with systemic steroid use, a known risk factor for infection. Post-operative dislocation occurred in 4.3% of cases, with re-operation needed in 3.9%. The dislocation rate was related to surgery type: 5.2% in THA, 0.9% in BP, and 0% in tRS and hRS. Among total arthroplasties with six month or longer follow-up (3670 THAs and 159 tRSs), the risk factors for post-operative dislocation were younger (≤ 40 years) or older (≥ 62 years) age, higher body weight, posterolateral approach, and smaller prosthetic head diameter. Regarding the need for re-operation, higher body weight and surgery type were identified as risk factors.
The relatively high dislocation rate of 5.2% in THA is a cause for concern. The identified risk factors for dislocation should be considered when selecting THA for treatment. Prosthesis survivorship in hRSs was inferior to that in BPs or THAs. Body weight also affected the survivorship of hip arthroplasties.
在一个大型队列中确定与股骨头坏死（ONFH）患者术后脱位和再次手术相关的可改变因素。
我们研究了4995例髋关节置换术：79%的患者接受了全髋关节置换术（THA）；17%接受了双极半髋关节置换术（BP）；3%接受了全表面置换术（tRS）；1%接受了半表面置换术（hRS）。一种新型的BP（占BP的49%）包括一个股骨部件，其颈部经过抛光或光滑处理，直径较小（约10毫米），轴向切面为圆形或椭圆形，无尖角。
尽管58%的ONFH病例与全身使用类固醇有关，而类固醇是已知的感染风险因素，但感染率相对较低（0.56%）。4.3%的病例发生了术后脱位，3.9%的病例需要再次手术。脱位率与手术类型有关：THA为5.2%，BP为0.9%，tRS和hRS为0%。在随访6个月或更长时间的全关节置换术中（3670例THA和159例tRS），术后脱位的风险因素为年龄较小（≤40岁）或较大（≥62岁）、体重较高、后外侧入路以及假体头直径较小。关于再次手术的必要性，体重较高和手术类型被确定为风险因素。
THA中相对较高的5.2%的脱位率令人担忧。在选择THA进行治疗时应考虑已确定的脱位风险因素。hRS的假体生存率低于BP或THA。体重也影响髋关节置换术的生存率。
