Bernhard Meredith E, Barnes C Lowry, DeFeo Brian M, Kaste Sue C, Wang Xiaoqing, Lu Zhaohua, Neel Michael D
Division of Orthopaedics, Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Arthroplasty. 2021 Apr;36(4):1352-1360. doi: 10.1016/j.arth.2020.10.019. Epub 2020 Oct 19.
Osteonecrosis of the femoral head (ONFH) is a potentially severe toxicity associated with glucocorticoid treatment for pediatric hematologic malignancy. We examined clinical outcomes of THA in adolescents and young adults treated for hematologic malignancies who developed advanced ONFH.
In a single-institution cohort, we retrospectively reviewed medical records and imaging for perioperative complications, reoperations, functional assessment at last follow-up, and radiological outcomes. Twenty-seven patients (41 hips) underwent THA (bilateral in 14 patients). There were 11 males. Median (interquartile range [IQR]) age at primary diagnosis was 14.9 years [1.8-18.9]. The median (IQR) age at THA was 19.8 years [14.6-30.3]. Mean (range) post-THA follow-up was 111.5 months (65.4-165.8).
Perioperative complications included one intraoperative calcar fracture that was secured with a cerclage wire and one posterior hip dislocation that occurred 6 days postoperatively, requiring closed reduction. One hip required a revision 21.1 months post-THA due to a fractured ceramic liner. The radiographic review was available for 38 of 41 hips and demonstrated none with loosening, subsidence, or osteolysis; nine developed periacetabular stress shielding. Incidence of stress shielding was associated with increased postoperative pain (P = .0130). There was a significant functional improvement in range of motion (ROM), pain, use of supports, participation in school, work, and sports, and use of pain medication from preoperative to postoperative clinical visits (P < .001).
Total hip arthroplasty in adolescents and young adults offers symptomatic and functional improvement in patients with ONFH. We found it to be safe with low perioperative complication rates even in patients undergoing active treatment for malignancy.
Level IV, case series study. See Instructions for authors for a complete description of levels of evidence.
股骨头坏死（ONFH）是小儿血液系统恶性肿瘤糖皮质激素治疗相关的一种潜在严重毒性反应。我们研究了因血液系统恶性肿瘤接受治疗且发生晚期ONFH的青少年和青年成人患者行全髋关节置换术（THA）的临床结局。
在一个单机构队列中，我们回顾性分析了病历及影像学资料，以评估围手术期并发症、再次手术情况、末次随访时的功能评估及影像学结局。27例患者（41髋）接受了THA（14例为双侧手术）。其中男性11例。初次诊断时的中位（四分位间距[IQR]）年龄为14.9岁[1.8 - 18.9]。THA时的中位（IQR）年龄为19.8岁[14.6 - 30.3]。THA后的平均（范围）随访时间为111.5个月（65.4 - 165.8）。
围手术期并发症包括1例术中股骨距骨折，用环扎钢丝固定；1例术后6天发生的髋关节后脱位，需手法复位。1髋在THA后21.1个月因陶瓷内衬骨折而需翻修。41髋中的38髋有影像学复查资料，均未显示松动、下沉或骨溶解；9髋出现髋臼周围应力遮挡。应力遮挡的发生率与术后疼痛增加相关（P = 0.0130）。从术前到术后临床随访，患者在活动范围（ROM）、疼痛、辅助器具使用、参与学校、工作和运动以及止痛药物使用方面有显著的功能改善（P < 0.001）。
青少年和青年成人行全髋关节置换术可改善ONFH患者的症状和功能。我们发现即使是正在接受恶性肿瘤积极治疗的患者，该手术也是安全的，围手术期并发症发生率低。
IV级，病例系列研究。有关证据级别的完整描述，请参阅作者指南。
