Sidhu Gur Aziz Singh, Kaur Harjot, Singh Hakam, Hind Jamie, Ashwood Neil
Trauma and Orthopaedics, University Hospitals of Derby and Burton, Burton, GBR.
Trauma and Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, IND.
Cureus. 2021 Jan 10;13(1):e12610. doi: 10.7759/cureus.12610.
Introduction Large-diameter femoral heads (≥36 mm) were introduced to decrease instability and improve the range of motion of the hip. We hypothesized regarding the clinical outcome and complications (dislocation, implant survivorship, and functional scores) following total hip replacement (THR) surgery in an Indian population who have smaller acetabulum compared to the western population. Methodology A prospective study was conducted at a tertiary hospital from November 2011 to July 2013. A total of 70 patients with hip pathology were operated by a senior surgeon for THR using the anterolateral approach. The Harris Hip Scores were recorded pre and postoperatively in all patients. Postoperatively, radiographs were taken to check for evidence of implant loosening or osteolysis. The patients were followed up till a mean follow-up of 86.52 months (range: 74 to 108 months) in our cohort. Detailed clinical and radiographic results were available for 59 patients, while six died (three died of myocardial infarction (MI), two had cerebrovascular accident (CVA), and one patient died of pulmonary embolism) and five patients were lost to follow-up. Results Of the 59 hips, majority (76%) had acetabular inclination of 46-55 degrees. Ninety percent of the stems were in the central position and 10% were in the varus position. The average preoperative Harris Hip Score was 38.8 ± 5.7 (range: 24-46), which increased to 90.4 ± 7.3 (range: 78-94) at the last follow-up. A total of six patients died (four died of MI and two of CVA) and two patients had infection which was treated with antibiotics. Three cases of dislocation were observed; one following a fall one year after surgery and revision total hip arthroplasty was done and two cases while getting up from the bed which were managed with closed reduction and abduction brace for six weeks. Two cases of periprosthetic fracture were observed which were managed with plating. Conclusion Lower dislocation rate and better range of movement reinforces the advantage of large-diameter femoral head during THR in the Indian population.
引言 大直径股骨头（≥36毫米）被引入以减少髋关节不稳定并改善其活动范围。我们针对印度人群全髋关节置换（THR）手术后的临床结果及并发症（脱位、植入物存活率和功能评分）提出了假设，印度人群的髋臼比西方人群小。方法 2011年11月至2013年7月在一家三级医院进行了一项前瞻性研究。共有70例髋关节病变患者由一位资深外科医生采用前外侧入路进行THR手术。所有患者术前和术后均记录Harris髋关节评分。术后拍摄X线片以检查植入物松动或骨溶解的迹象。在我们的队列中，患者平均随访86.52个月（范围：74至108个月）。59例患者有详细的临床和影像学结果，6例死亡（3例死于心肌梗死（MI），2例发生脑血管意外（CVA），1例死于肺栓塞），5例失访。结果 在59例髋关节中，大多数（76%）髋臼倾斜度为46 - 55度。90%的股骨柄处于中心位置，10%处于内翻位置。术前Harris髋关节评分平均为38.8±5.7（范围：24 - 46），在最后一次随访时增至90.4±7.3（范围：78 - 94）。共有6例患者死亡（4例死于MI，2例死于CVA），2例患者发生感染，经抗生素治疗。观察到3例脱位；1例在术后1年跌倒后发生，行翻修全髋关节置换术，2例在起床时发生，采用闭合复位和外展支具固定6周。观察到2例假体周围骨折，采用钢板固定治疗。结论 较低的脱位率和更好的活动范围强化了大直径股骨头在印度人群THR手术中的优势。
