From the Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont. (Mei, Safir, Gross, Kuzyk); and the Department of Family Medicine, Queen’s University, Kingston, Ont. (Gong).
Can J Surg. 2019 Aug 1;62(4):249-258. doi: 10.1503/cjs.013118.
Total hip arthroplasty (THA) is increasingly performed in younger patients despite the lack of comprehensive assessment of long-term outcomes. We systematically reviewed the contemporary literature to assess the 1) indications, 2) implant selection and long-term survivorship, 3) complication and reoperation rates and 4) radiographic and functional outcomes of primary THA in patients younger than 55 years.
We searched the Embase and MEDLINE databases for English-language articles published between 2000 and 2018 that reported outcomes of primary THA in patients younger than 55 years with a minimum follow-up duration of 10 years.
Thirty-two studies reporting on 3219 THA procedures performed in 2434 patients met our inclusion criteria. The most common preoperative diagnoses were avascular necrosis (1044 [32.4%]), osteoarthritis (870 [27.0%]) and developmental dysplasia of the hip (627 [19.5%]). Modular implants (3001 [93.2%]), cementless fixation (2214 [68.8%]) and metal-on-polyethylene bearings (1792 [55.7%]) were frequently used. The mean 5- and 10-year survival rates were 98.7% and 94.6%, respectively. Data on survival beyond 10 years were heterogeneous, with values of 27%–99.5% at 10–14 years, 59%–84% at 15–19 years, 70%–77% at 20–24 years and 60% at 25–30 years. Rates of dislocation, deep infection and reoperation for any reason were 2.4%, 1.2% and 16.3%, respectively. The mean Harris Hip Score improved from 43.6/100 to 91.0/100.
Total hip arthroplasty in patients younger than 55 years provides reliable outcomes at up to 10 years. Future studies should evaluate the outcomes of THA in this population at 15–20 years’ follow-up.
尽管缺乏对长期结果的全面评估，全髋关节置换术（THA）在年轻患者中的应用越来越多。我们系统地回顾了当代文献，以评估 1）适应证，2）假体选择和长期生存率，3）并发症和再次手术率，以及 4）55 岁以下患者初次 THA 的放射学和功能结果。
我们检索了 Embase 和 MEDLINE 数据库，以获取 2000 年至 2018 年间发表的报告 55 岁以下患者初次 THA 结果的英文文章，最低随访时间为 10 年。
符合纳入标准的 32 项研究共报告了 3219 例 THA 手术，涉及 2434 例患者。最常见的术前诊断是股骨头坏死（1044 [32.4%]）、骨关节炎（870 [27.0%]）和发育性髋关节发育不良（627 [19.5%]）。模块化假体（3001 [93.2%]）、非骨水泥固定（2214 [68.8%]）和金属对聚乙烯轴承（1792 [55.7%]）被广泛应用。平均 5 年和 10 年的生存率分别为 98.7%和 94.6%。10-14 年的生存率为 27%-99.5%，15-19 年为 59%-84%，20-24 年为 70%-77%，25-30 年为 60%，超过 10 年的数据差异较大。脱位、深部感染和因任何原因再次手术的发生率分别为 2.4%、1.2%和 16.3%。平均 Harris 髋关节评分从 43.6/100 提高到 91.0/100。
55 岁以下患者的全髋关节置换术可提供长达 10 年的可靠结果。未来的研究应评估该人群在 15-20 年随访时的 THA 结果。
