髋关节翻修术中的大转子延长截骨术：612 髋的当代疗效。

Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty: Contemporary Outcomes of 612 Hips.

机构信息

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

出版信息

J Bone Joint Surg Am. 2021 Jan 20;103(2):162-173. doi: 10.2106/JBJS.20.00215.

DOI:10.2106/JBJS.20.00215

PMID:33252587

Abstract

BACKGROUND

Extended trochanteric osteotomies (ETOs) provide wide femoral and acetabular exposure, give direct access to the femoral medullary canal, and facilitate implant removal and new implant placement during selected revision total hip arthroplasties (THAs). Previous studies are limited by modest patient numbers and limited length of follow-up. The goals of the current study were to assess the union rate, complications, and outcomes of contemporary ETOs performed during revision THAs.

METHODS

From 2003 to 2013, 612 ETOs were performed during revision THAs at 1 institution using 2 techniques: Paprosky (laterally based osteotomy; n = 367) and Wagner (anteriorly based osteotomy; n = 245). The indications for the revision procedures were aseptic loosening (65%), periprosthetic joint infection (18%), periprosthetic fracture (6%), femoral implant fracture (5%), and other (6%). The mean patient age was 69 years, and 57% of the patients were male. The mean number of previous THAs was 1.6. The median duration of follow-up was 5 years (range, 2 to 13 years).

RESULTS

The mean Harris hip scores increased from 57 preoperatively to 77 at the latest follow-up (p < 0.001). Radiographic and clinical union was achieved in 98% of the patients at a mean of 6 months (range, 1 to 24 months). The mean migration of the proximal trochanteric osteotomy fragment prior to union was 3 mm (range, 0 to 29 mm). ETO fragment migration of >1 cm occurred in 7% (37) of the 501 hips that had radiographic analysis. Nine hips (2%) had nonunion of the ETO. Intraoperative fracture of the ETO diaphyseal fragment occurred in 22 hips (4%), postoperative fracture of the ETO diaphyseal fragment occurred in 3 hips (0.5%), and postoperative fracture of the greater trochanter occurred in 41 hips (7%). Survivorship at 10 years free of revision for aseptic femoral loosening, free of femoral or acetabular component removal or revision for any reason, and free of reoperation for any reason was 97%, 91%, and 82%, respectively.

CONCLUSIONS

This large series of ETOs shows that the union rate is high and clinically important trochanteric migration is infrequent. The most common complications are fracture of the osteotomy fragment intraoperatively or postoperatively.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

延长转子间截骨术（ETO）可提供广泛的股骨和髋臼显露，直接进入股骨髓腔，并在选择的翻修全髋关节置换术（THA）中便于假体取出和新假体植入。既往研究的病例数有限，随访时间有限。本研究的目的是评估在翻修 THA 中进行的当代 ETO 的愈合率、并发症和结果。

方法

2003 年至 2013 年，在 1 家机构中，使用 2 种技术（Paprosky：外侧基于截骨术；n=367 和 Wagner：前基于截骨术；n=245）对 612 例翻修 THA 行 ETO。翻修手术的指征包括无菌性松动（65%）、假体周围关节感染（18%）、假体周围骨折（6%）、股骨假体骨折（5%）和其他（6%）。患者平均年龄 69 岁，57%为男性。平均既往 THA 数为 1.6 次。中位随访时间为 5 年（范围，2 至 13 年）。

结果

术前平均 Harris 髋关节评分为 57 分，末次随访时提高至 77 分（p<0.001）。98%的患者在平均 6 个月（范围，1 至 24 个月）时达到影像学和临床愈合。在愈合前，近端转子间截骨碎片的平均迁移距离为 3mm（范围，0 至 29mm）。501 髋中有 7%（37 髋）存在影像学分析提示 ETO 碎片迁移>1cm。9 髋（2%）出现 ETO 不愈合。22 髋（4%）术中发生 ETO 骨干骨折，3 髋（0.5%）术后发生 ETO 骨干骨折，41 髋（7%）术后发生大转子骨折。10 年时，无菌性股骨松动翻修、股骨或髋臼组件取出或任何原因翻修以及任何原因再手术的无翻修生存率分别为 97%、91%和 82%。