From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Am Acad Orthop Surg. 2019 Dec 15;27(24):933-938. doi: 10.5435/JAAOS-D-17-00842.
Contemporary failure etiologies of primary total hip arthroplasties (THAs) have not been precisely defined because of heterogeneity of referral practices.
A single-institution registry of 4,555 primary, noncemented THAs performed by subspecialty trained arthroplasty surgeons between 2000 and 2012 was analyzed. Only revision surgeries and revisions that occurred after THAs initially performed at the institution were included.
The estimated 10-year survivorships free from THA revision surgery, modular implant revision, and nonmodular implant revision were 98.2%, 98.1%, and 96.3%, respectively. The most common reasons for revision surgeries were wound-related complications (49%), periprosthetic fracture (25%), and pain (18%). Hip instability (53%) and acute periprosthetic joint infection (26%) were the most common etiologies of revision procedures with isolated exchange of at least one modular implant. The most common reasons for replacement or removal of nonmodular implant were periprosthetic fracture (32%), aseptic loosening (22%), and adverse tissue reaction (17%).
Focusing on primary THAs initially performed by a contemporary, subspecialty practice allowed an accurate determination of etiologies and rates of failure (defined by revision surgery or revision) after THA.
Level IV.
由于转诊实践的异质性，原发性全髋关节置换术（THA）的当代失败病因尚未得到准确界定。
对 2000 年至 2012 年间由专业关节置换外科医生进行的 4555 例原发性非骨水泥 THA 的单机构登记处进行了分析。仅包括翻修手术和在该机构初次进行 THA 后发生的翻修。
估计 10 年无 THA 翻修手术、模块化植入物翻修和非模块化植入物翻修的生存率分别为 98.2%、98.1%和 96.3%。翻修手术最常见的原因是伤口相关并发症（49%）、假体周围骨折（25%）和疼痛（18%）。髋关节不稳定（53%）和急性假体周围关节感染（26%）是最常见的病因，需要至少更换一个模块化植入物的翻修手术。更换或移除非模块化植入物的最常见原因是假体周围骨折（32%）、无菌性松动（22%）和组织不良反应（17%）。
专注于由当代专业实践进行的初次 THA，可以准确确定 THA 后病因和失败率（通过翻修手术或翻修来定义）。
IV 级。
