Park Chan-Woo, Lim Seung-Jae, Kim Joo-Hwan, Park Youn-Soo
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Orthop Translat. 2020 Jan 6;21:41-48. doi: 10.1016/j.jot.2019.12.005. eCollection 2020 Mar.
Hip resurfacing arthroplasty (HRA) may be a suitable option for treating osteonecrosis of the femoral head (ONFH). However, concerns regarding the extent of osteonecrosis, amount of defect under the prosthesis, and implant-related complications remain. This study aimed to report implant-specific outcomes and risk factors for failure of HRA in ONFH.
A total of 202 HRAs (166 patients) performed by a single surgeon were investigated. The stage, size, and location of ONFH were evaluated using preoperative radiographs and magnetic resonance images. Clinical, radiographic results, and serum metal concentrations of articular surface replacement (ASR) and non-ASR devices were compared. Logistic regression analysis was performed to identify the contributors of failures. The mean follow-up duration was 10.6 years.
Twenty-six hips (12.9%) were operated with Birmingham Hip Resurfacing (BHR), 99 (49.0%) with ASR, and 77 (38.1%) with Conserve Plus. The mean Harris Hip Score improved from 52.1 to 93.2 at the final follow-up (P < 0.001). Revision-free survivorships of non-ASR and ASR implants were 99.0% and 82.4%, respectively (P < 0.001). In multivariate analysis, the use of ASR prosthesis, greater combined necrotic angle, and smaller head size were associated with revision surgery. A large combined necrotic angle was the only independent risk factor for mechanical failure at the femoral side (P = 0.029).
HRA for ONFH using BHR and Conserve Plus implants demonstrated favourable clinical outcomes with high revision-free survival rates at 10 years. However, care should be taken for large necrotic lesions that can lead to femoral neck fracture or aseptic femoral loosening.
This study suggests HRA performed for appropriately selected patients with ONFH can show excellent long-term clinical results. Therefore, HRA should remain as one of the treatment options for ONFH, and further development of HRA implants should be continued.
髋关节表面置换术（HRA）可能是治疗股骨头坏死（ONFH）的一种合适选择。然而，对于坏死范围、假体下方缺损量以及与植入物相关的并发症仍存在担忧。本研究旨在报告HRA治疗ONFH的特定植入物结局及失败风险因素。
对由单一外科医生实施的202例HRA（166例患者）进行了调查。使用术前X线片和磁共振成像评估ONFH的分期、大小和位置。比较了关节表面置换（ASR）和非ASR装置的临床、影像学结果以及血清金属浓度。进行逻辑回归分析以确定失败的影响因素。平均随访时间为10.6年。
26髋（12.9%）采用伯明翰髋关节表面置换术（BHR），99髋（49.0%）采用ASR，77髋（38.1%）采用Conserve Plus。末次随访时，Harris髋关节评分平均从52.1提高到93.2（P < 0.001）。非ASR和ASR植入物的无翻修生存率分别为99.0%和82.4%（P < 0.001）。多因素分析显示，使用ASR假体、较大的坏死角总和以及较小的股骨头尺寸与翻修手术相关。较大的坏死角总和是股骨侧机械性失败的唯一独立风险因素（P = 0.029）。
使用BHR和Conserve Plus植入物的ONFH的HRA显示出良好的临床结局，10年无翻修生存率高。然而，对于可能导致股骨颈骨折或无菌性股骨松动的大坏死病变应予以关注。
本研究表明，为适当选择的ONFH患者进行的HRA可显示出优异的长期临床结果。因此，HRA应仍是ONFH的治疗选择之一，并应继续推进HRA植入物的进一步研发。
