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55岁及以下患者的全髋关节置换术:中期预后不良的危险因素。

Total hip arthroplasty in patients 55 years or younger: Risk factors for poor midterm outcomes.

作者信息

Halawi Mohamad J, Brigati David, Messner William, Brooks Peter J

机构信息

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, United States.

Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.

出版信息

J Clin Orthop Trauma. 2018 Apr-Jun;9(2):103-106. doi: 10.1016/j.jcot.2016.12.009. Epub 2017 Feb 9.

Abstract

BACKGROUND

Total hip arthroplasty (THA) is increasingly performed in younger patients. The purpose of this study is to report on the midterm outcomes of primary cementless THA in patients 55 years and younger; and specifically to examine the risk factors for aseptic failure, all-cause revision, and mortality in this patient population.

METHODS

Four hundred and twenty-six consecutive patients with minimum 5-year follow-up were retrospectively reviewed. Multivariate analyses were conducted to control for potential confounding factors identified by univariate analyses.

RESULTS

Mean follow-up was 92.12 ± 30.9 months. The overall 5-year implant survival rate was 90.8% and the aseptic survival rate was 92.6%. Among the potential risk factors, only bearing surface had a significant relationship with aseptic revision ( = 0.041). Aseptic revisions occurred more frequently with metal-on-polyethylene articulation ( = 0.012). Higher Charlson comorbidity index (CCI) was a significant risk factor for all-cause complications (P = 0.04) while higher CCI and lower body mass index were significant risk factors for mortality ( = 0.001 and 0.006 respectively).

CONCLUSION

Bearing type was the only risk factor for revision surgery, particularly metal-on-polyethylene bearing. Patients with higher comorbidities were at increased risk for postoperative complications and mortality, while higher body weight appeared to have a protective effect against mortality. These findings should be considered before surgery for risk modification and management of patient expectations. While it appears that bearing couples other than metal-on-polyethylene are especially suitable for young patients, more studies are needed to determine the best bearing couple and to reduce the rates of postoperative complications in this patient population.

摘要

背景

全髋关节置换术(THA)在年轻患者中的应用越来越多。本研究的目的是报告55岁及以下患者初次非骨水泥型THA的中期结果;并特别研究该患者群体中无菌性失败、全因翻修和死亡率的危险因素。

方法

回顾性分析426例至少随访5年的连续患者。进行多变量分析以控制单变量分析确定的潜在混杂因素。

结果

平均随访时间为92.12±30.9个月。总体5年植入物生存率为90.8%,无菌生存率为92.6%。在潜在危险因素中,只有承重面与无菌性翻修有显著关系(P=0.041)。金属对聚乙烯关节置换的无菌性翻修更频繁(P=0.012)。较高的Charlson合并症指数(CCI)是全因并发症的显著危险因素(P=0.04),而较高的CCI和较低的体重指数是死亡率的显著危险因素(分别为P=0.001和0.006)。

结论

承重类型是翻修手术的唯一危险因素,尤其是金属对聚乙烯承重。合并症较高的患者术后并发症和死亡率风险增加,而较高的体重似乎对死亡率有保护作用。在手术前应考虑这些发现,以进行风险调整和管理患者期望。虽然除金属对聚乙烯之外的其他承重组合似乎特别适合年轻患者,但需要更多研究来确定最佳承重组合并降低该患者群体的术后并发症发生率。

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