Pritchett James W
Seattle, Washington.
JB JS Open Access. 2020 May 11;5(2). doi: 10.2106/JBJS.OA.20.00004. eCollection 2020 Apr-Jun.
Most surgeons strongly prefer total hip arthroplasty (THA) over hip resurfacing arthroplasty (HRA). However, it is unknown whether patients prefer the results of 1 procedure over the other. The purpose of this study was to answer 3 questions: (1) Do patients with an HRA on 1 side and a THA on the other notice a difference? (2) Do patients have a preference? (3) What are the reasons for their preference?
Between 1998 and 2012, 332 patients underwent staged bilateral hip arthroplasties with cementless THA on 1 side and HRA on the other, with a highly cross-linked polyethylene acetabular component used for both. Patient preferences, Harris hip scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were recorded by blinded examiners. Patients provided reasons for their preference in semi-structured interviews using both quantitative and qualitative measures.
The mean follow-up was 11 years (range, 7 to 21 years). Of 324 patients with complete data, 279 (86%) preferred the HRA, 19 (6%) preferred the THA, and 26 (8%) had no preference. The most common reasons for preference for the HRA were better balance (n = 143), felt more normal (n = 141), better activity participation/more reliable hip during sports (n = 139), and stronger on stairs (n = 129). A fair or poor outcome was reported by the patient after 4 HRAs and 7 THAs. The remainder of the patients reported improved function and satisfactory pain relief and range of motion for both hips.
In conclusion, most patients in this study preferred the side on which the HRA had been done. Since essentially all current hip prostheses perform well, a paired bilateral study may be the optimal way to determine patient preferences and values of HRA compared with THA.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
大多数外科医生强烈倾向于全髋关节置换术（THA）而非髋关节表面置换术（HRA）。然而，尚不清楚患者是否更青睐其中一种手术的结果。本研究的目的是回答三个问题：（1）一侧接受HRA而另一侧接受THA的患者是否能察觉到差异？（2）患者是否有偏好？（3）他们偏好的原因是什么？
1998年至2012年期间，332例患者接受了分期双侧髋关节置换术，一侧为非骨水泥型THA，另一侧为HRA，两者均使用高度交联聚乙烯髋臼组件。由不知情的检查人员记录患者的偏好、Harris髋关节评分以及西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分。患者在半结构化访谈中使用定量和定性方法提供偏好的原因。
平均随访时间为11年（范围7至21年）。在324例有完整数据的患者中，279例（86%）更喜欢HRA，19例（6%）更喜欢THA，26例（8%）无偏好。更喜欢HRA的最常见原因是平衡更好（n = 143）、感觉更正常（n = 141）、运动时活动参与度更高/髋关节更可靠（n = 139）以及上楼梯时更强壮（n = 129）。4例HRA和7例THA术后患者报告效果一般或较差。其余患者报告双侧髋关节功能均有改善，疼痛缓解和活动范围令人满意。
总之，本研究中的大多数患者更喜欢接受HRA的那一侧。由于目前基本上所有髋关节假体的性能都良好，配对双侧研究可能是确定与THA相比患者对HRA的偏好和价值的最佳方法。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
