Department of Orthopaedic Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY.
J Arthroplasty. 2021 Jun;36(6):2049-2054.e5. doi: 10.1016/j.arth.2021.02.004. Epub 2021 Feb 6.
Treatment options for metastatic osseous lesions of the proximal femur include hemiarthroplasty (HA) or total hip arthroplasty (THA) depending on lesion characteristics and patient demographics. Studies assessing short-term outcomes after HA/THA in this patient population are limited. Therefore, the purpose of this present study was to identify short-term rates of morbidity and mortality after HA/THA for pathological proximal femur fractures, as well as readmission and reoperation rates and reasons.
This study utilized a large, prospectively collected registry to identify patients who underwent HA/THA between 2011 and 2018. Patients were stratified by indication for surgery, including pathological fracture, nonpathological fracture, and osteoarthritis. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis.
In total, 883 patients undergoing HA/THA for a pathological fracture were identified. Relative to an osteoarthritis cohort, these patients tended to be older, had a lower body mass index, and had significantly more preoperative comorbidities. These patients had high rates of total complications (13.93%), including thirty-day mortality (3.29%), unplanned return to the operating room (4.98%), and pulmonary complications (3.85%). Patients with pathological fracture had a longer operative duration relative to osteoarthritis and nonpathological cohorts (+27 and +25 minutes, respectively), despite having high rates of HAs performed.
Patients undergoing hip arthroplasty for pathologic proximal femur fracture have increased morbidity and mortality relative to an osteoarthritis cohort. However, patients with a pathological fracture have similar rates of morbidity and mortality when compared with a nonpathological fracture cohort, but did experience higher rates of perioperative blood transfusion and unplanned readmissions.
III.
对于股骨近端转移性骨病变，治疗方案包括半髋关节置换术（HA）或全髋关节置换术（THA），这取决于病变特征和患者人口统计学特征。评估该患者人群中 HA/THA 短期疗效的研究有限。因此，本研究旨在确定 HA/THA 治疗病理性股骨近端骨折的短期发病率和死亡率，以及再入院率和再手术率及原因。
本研究利用大型前瞻性收集的注册数据库来确定 2011 年至 2018 年间接受 HA/THA 的患者。根据手术指征将患者分层，包括病理性骨折、非病理性骨折和骨关节炎。使用双变量和/或多变量分析比较基线患者特征和术后并发症。
共确定了 883 例因病理性骨折而行 HA/THA 的患者。与骨关节炎组相比，这些患者年龄更大，体重指数更低，术前合并症更多。这些患者的总并发症发生率很高（13.93%），包括 30 天死亡率（3.29%）、非计划再次手术（4.98%）和肺部并发症（3.85%）。与骨关节炎和非病理性骨折组相比，病理性骨折组的手术时间明显更长（分别增加 27 分钟和 25 分钟），尽管 HA 手术比例较高。
与骨关节炎组相比，因股骨近端病理性骨折而行髋关节置换术的患者发病率和死亡率更高。然而，与非病理性骨折组相比，病理性骨折患者的发病率和死亡率相似，但围手术期输血和非计划再入院的发生率更高。
III。
