Lim Seung-Jae, Park Chan-Woo, Kim Dong-Uk, Han Kwangjoon, Seo Minkyu, Moon Young-Wan, Lee Jung-Il, Park Youn-Soo
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
J Clin Med. 2019 Oct 16;8(10):1703. doi: 10.3390/jcm8101703.
Corticosteroids have been widely used in patients with brain tumors to reduce tumor-associated edema and neurological deficits. This study examined the outcomes of total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) following brain tumor surgery. We identified 34 THAs performed in 26 patients with steroid-induced ONFH among 9254 patients undergoing surgical treatment for primary brain tumors. After propensity score matching with demographics, 68 THAs (52 patients) in ONFH unrelated to brain tumors were selected as the control group. At the time of THA, 54% of brain tumor patients had neurological sequelae and 46% had adrenal insufficiency. After THA, patients with brain tumor required longer hospital stay, reported a lower functional score, and showed a higher rate of heterotopic ossification compared to the control group. However, hip pain score improved significantly after THA in the brain tumor group, and did not differ from that of the control group (-value = 0.168). Major complication rates were similar (2.9% and 1.5% for the brain tumor and control groups, respectively; -value = 1.000), and implant survivorships were not different at 7 years (100% and 98.1% for the brain tumor and control groups, respectively; -value = 0.455). Our findings suggest that THA can be safely performed to reduce hip pain in patients with steroid-induced ONFH after surgical treatment of primary brain tumors.
皮质类固醇已广泛应用于脑肿瘤患者，以减轻肿瘤相关水肿和神经功能缺损。本研究调查了脑肿瘤手术后股骨头缺血性坏死（ONFH）患者行全髋关节置换术（THA）的结果。我们在9254例接受原发性脑肿瘤手术治疗的患者中，确定了26例患有类固醇诱导型ONFH的患者进行了34次THA手术。在根据人口统计学进行倾向得分匹配后，选择68例与脑肿瘤无关的ONFH患者进行的THA手术（52例患者）作为对照组。在进行THA时，54%的脑肿瘤患者有神经后遗症，46%有肾上腺功能不全。与对照组相比，脑肿瘤患者THA术后住院时间更长，功能评分更低，异位骨化发生率更高。然而，脑肿瘤组THA术后髋关节疼痛评分显著改善，与对照组无差异（P值=0.168）。主要并发症发生率相似（脑肿瘤组和对照组分别为2.9%和1.5%；P值=1.000），7年时植入物生存率无差异（脑肿瘤组和对照组分别为100%和98.1%；P值=0.455）。我们的研究结果表明，对于原发性脑肿瘤手术治疗后患有类固醇诱导型ONFH的患者，可安全地进行THA以减轻髋关节疼痛。
