Trevisan Carlo, Klumpp Raymond, Piscitello Stefano, Compagnoni Riccardo, Grattieri Roberto, Cazzaniga Carlo
Orthopaedics and Traumatology of the University of Milano-Bicocca, Milano, Italy.
Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy.
Eur J Orthop Surg Traumatol. 2020 Dec;30(8):1463-1470. doi: 10.1007/s00590-020-02727-x. Epub 2020 Jul 1.
Accurate reconstruction of biomechanical parameters following total hip arthroplasty (THA) is crucial for good joint function. We investigated how reconstruction parameters achieved by minimally invasive anterior (MIS) THA may influence function and patient-related outcomes.
A consecutive series of 95 patients treated by MIS THA for primary osteoarthritis were retrospectively reviewed. Primary outcome measures were Harris Hip Score (HHS), hip disability and osteoarthritis outcome score (HOOS) and EQ-5D. Femoral offset (FO), abductor lever arm (ALA), centre of rotation (CoR), leg length discrepancy (LLD), cup version and stem alignment were measured pre- and post-operatively. Obtained reconstruction parameters compared to the contralateral hip were used as independent variables in a multivariate regression with each primary outcome measure as dependent variable.
Mean age at surgery was 69 years. HHS rated 94.7% of patients as good/excellent and mean EQ-5D was 0.82. Post-operative HOOS subscales showed no statistical difference compared to the Italian benchmark population. Stem alignment averaged 0.2° valgus, mean cup inclination was 37.8° and mean anteversion was 12.8°. When compared to the contralateral side, CoR was post-operatively elevated by 2.6 mm and medialized by 2.4 mm averagely. An average FO reduction of -0.5 mm was observed while FO ratio increased by 1.9% averagely. ALA decreased by -3.3 mm while LLD was 2.3 mm averagely. Multivariate regression analysis revealed a significant contribution of ALA to HHS only.
Biomechanical parameters achieved by MIS THA are satisfactory with negligible impact on functional results and no impact on patient-related outcomes certifying the high quality achieved in THA.
全髋关节置换术（THA）后生物力学参数的准确重建对于良好的关节功能至关重要。我们研究了微创前路（MIS）THA所实现的重建参数如何影响功能及与患者相关的结局。
回顾性分析了连续95例因原发性骨关节炎接受MIS THA治疗的患者。主要结局指标为Harris髋关节评分（HHS）、髋关节功能障碍和骨关节炎结局评分（HOOS）以及EQ-5D。术前和术后测量股骨偏心距（FO）、外展肌杠杆臂（ALA）、旋转中心（CoR）、下肢长度差异（LLD）、髋臼杯倾斜度和股骨柄对线情况。将获得的与对侧髋关节相比的重建参数作为多变量回归中的自变量，每个主要结局指标作为因变量。
手术时的平均年龄为69岁。HHS将94.7%的患者评为良好/优秀，平均EQ-5D为0.82。术后HOOS子量表与意大利基准人群相比无统计学差异。股骨柄对线平均外翻0.2°，髋臼杯平均倾斜度为37.8°，平均前倾角为12.8°。与对侧相比，术后CoR平均升高2.6 mm并向内移2.4 mm。观察到FO平均减少-0.5 mm，而FO比率平均增加1.9%。ALA减少-3.3 mm，而LLD平均为2.3 mm。多变量回归分析显示ALA仅对HHS有显著影响。
MIS THA所实现的生物力学参数令人满意，对功能结果的影响可忽略不计，对与患者相关的结局无影响，证明了THA所达到的高质量。
