University of Regensburg, Department of Trauma Surgery, University Medical Center, Regensburg, Germany.
University of Regensburg, Department of Orthopedic Surgery, Asklepios Medical Center, Bad Abbach, Germany.
Sci Rep. 2020 Apr 28;10(1):7107. doi: 10.1038/s41598-020-62531-9.
Persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 ± 6.0 mm than patients without symptoms in the trochanteric region with 7.8 ± 5.3 mm (p = 0.01). Patients with an absolute deviation of the combined parameters of more than 5 mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5 mm compared to the non-affected contralateral side (8.0%, 2/25, p = 0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p < 0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p < 0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients.
大转子周围持续性疼痛是全髋关节置换术后的常见并发症。在 THA 中，恢复下肢长度、股骨和髋臼外展等生物力学至关重要。本研究旨在评估 THA 后这些参数的术后差异，并分析其与大转子疼痛综合征的关系。此外，我们旨在评估与患者报告的结果测量相比，转子间疼痛综合征的临床相关性。对 90 例微创全髋关节置换术后患者的 3D-CT 扫描进行分析，并测量下肢长度、股骨和髋臼外展差异。THA 后 3 年对转子间疼痛综合征的存在进行临床评估，并使用结果测量进行评估。此外，还评估了患者的预期。与转子间区域无症状的患者（7.8±5.3mm）相比，有转子间疼痛综合征的患者在下肢长度、股骨和髋臼外展联合重建的绝对差异更大（11.8±6.0mm）（p=0.01）。有转子间疼痛症状的患者，绝对差值超过 5mm 的患者比生物力学恢复在 5mm 以内的患者更频繁地抱怨转子间症状（29.2%，19/65）（p=0.03）。与非受累对侧相比，THA 后 3 年的临床结果在有转子间疼痛症状的患者中显著降低（p<0.03）。同样，THR-Survey 测量的患者期望满意度在有转子间疼痛的患者中较低（p<0.005）。下肢长度、髋臼和股骨外展的精确联合重建可显著减少术后转子间疼痛综合征，并改善患者的临床结果。
