Baba Shoji, Motomura Goro, Ikemura Satoshi, Yamaguchi Ryosuke, Hamai Satoshi, Fujii Masanori, Kawano Koichiro, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Mod Rheumatol. 2021 May;31(3):725-732. doi: 10.1080/14397595.2020.1775959. Epub 2020 Jul 14.
This study aimed to report the mid-term radiological outcomes of patients with bipolar hemiarthroplasty (BHA) for stage 3 osteonecrosis of the femoral head (ONFH), and to identify the risk factors for postoperative radiological changes.
We retrospectively investigated 62 patients (38 men and 24 women; mean age, 50.1 years) aged <70 years who underwent primary BHA for Association Research Circulation Osseous stage 3 ONFH between 1998 and 2010. The mean follow-up period after BHA was 12.8 years. The following changes were assessed on follow-up radiographs: outer head migration, polyethylene wear, and femoral osteolysis. The association between demographic data and the development of postoperative radiological changes was evaluated.
Radiological changes were found in 20 hips (32.3%) at a mean of 8.1 years after BHA; of these, three hips (4.8%) underwent total hip arthroplasty conversion at a mean of 10.9 years after BHA. Both univariate and multivariate analysis revealed that younger age and female sex were independent risk factors for the development of postoperative radiological changes.
The current results suggest that the indication of BHA should be carefully determined in young or female patients with ONFH, even when the disease is in the early stage.
本研究旨在报告采用双极半髋关节置换术（BHA）治疗股骨头缺血性坏死（ONFH）3期患者的中期影像学结果，并确定术后影像学改变的危险因素。
我们回顾性研究了1998年至2010年间62例年龄小于70岁、因骨循环研究协会（ARCO）3期ONFH接受初次BHA手术的患者（38例男性和24例女性；平均年龄50.1岁）。BHA术后平均随访时间为12.8年。在随访X线片上评估以下变化：股骨头外移、聚乙烯磨损和股骨骨质溶解。评估人口统计学数据与术后影像学改变发生之间的关联。
BHA术后平均8.1年时，20髋（32.3%）出现影像学改变；其中，3髋（4.8%）在BHA术后平均10.9年时接受了全髋关节置换术翻修。单因素和多因素分析均显示，年龄较小和女性是术后影像学改变发生的独立危险因素。
目前的结果表明，对于ONFH的年轻或女性患者，即使疾病处于早期，也应谨慎确定BHA的适应证。
