From the Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, University Campus, Western University, London, Ont. (Wood, Alzahrani, Vasarhelyi, Lanting); the Department of Orthopaedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (Alzahrani); the School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ont. (Marsh); and the Bone and Joint Institute, Western University, London, Ont. (Marsh, Vasarhelyi, Lanting).
Can J Surg. 2019 Apr 1;62(2):78-82. doi: 10.1503/cjs.002318.
With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems.
We retrospectively identified patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients’ charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively.
We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no significant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was significantly shorter and total cost was significantly lower (mean difference –3707.64, 95% confidence interval –5532.85 to –1882.43) with a primary stem than with other revision femoral stems.
We found similar clinical outcomes and significant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA.
随着全髋关节置换术（THA）数量的不断增加，翻修手术的比例也在相应增加，导致医疗保健支出增加。本研究旨在评估使用带领圈的全羟基磷灰石涂层初次股骨柄进行翻修 THA 与常用的翻修股骨柄相比的临床效果和成本。
我们回顾性地确定了 2011 年至 2016 年间接受初次股骨柄翻修 THA 的患者，并根据人口统计学变量和翻修原因与接受相似的翻修 THA 患者进行匹配。我们从患者病历中提取手术数据和住院资源使用信息，以计算每例手术的平均成本。患者报告的结果在术前和术后 1 年进行记录。
我们的分析纳入了 20 例患者，其中 10 例接受了初次股骨柄，10 例接受了常规翻修股骨柄。两组在 Western Ontario 和 McMaster 大学骨关节炎指数评分、Harris 髋关节评分、12 项简短健康调查（SF-12）精神综合评分或身体综合评分方面的平均差异均无统计学意义。初次股骨柄组的手术时间明显更短，总费用明显更低（平均差值为-3707.64，95%置信区间为-5532.85 至-1882.43）。
我们发现初次股骨柄在翻修 THA 中具有相似的临床效果和显著的机构成本节约。这表明带领圈的全羟基磷灰石涂层初次股骨柄在翻修 THA 中具有一定的作用。
