From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr. Greig, Dr. Hsiue, Mr. Chen, Dr. Trikha, and Dr. Stavrakis), and the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario (Dr. Khoshbin), Canada.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jul;4(7):e2000121. doi: 10.5435/JAAOSGlobal-D-20-00121.
Acetabular protrusio (AP) is associated with distorted anatomic landmarks and insufficient bone stock that increases complexity of total hip arthroplasty (THA). This study used a large national database to compare outcomes after THA in patients with and without AP.
The Nationwide Readmissions Database was used to identify patients with and without AP who underwent THA from 2010 to 2014. Primary outcomes analyzed included complications during index hospitalization and within 90 days of THA.
Propensity score matching generated 4,395 patients without AP and 4,603 patients with AP. Patients with AP were older (68.1 versus 65.2 years, P < 0.0001), more predominantly women (82.1% versus 55.9%), and had more medical comorbidities as measured by the Elixhauser Comorbidity Index (2.29 versus 1.89, P < 0.0001). Patients with AP had an increased risk of requiring bone graft (odds ratio [OR] = 47.97, 95% confidence interval [CI]: 14.27 to 161.22), receiving a blood transfusion (OR = 1.90, 95% CI: 1.57 to 2.29), and suffering a periprosthetic fracture (OR = 2.56, 95% CI: 1.10 to 5.97) within 90 days of THA. Length and cost of index hospitalization were greater for patients with AP (5.0 versus 4.3 days, P = 0.002; $19,211.88 versus $27,736.30, P < 0.0001).
Given the current emphasis on hospital cost optimization, it is important to ensure that patients with AP are managed appropriately. Attention should be placed on comprehensive preoperative planning and postoperative monitoring in this population.
髋臼前突（AP）与解剖标志扭曲和骨量不足有关，这增加了全髋关节置换术（THA）的复杂性。本研究使用大型国家数据库比较了有和无 AP 的 THA 患者的术后结果。
使用全国再入院数据库确定了 2010 年至 2014 年接受 THA 的有和无 AP 的患者。分析的主要结果包括索引住院期间和 THA 后 90 天内的并发症。
通过倾向评分匹配生成了 4395 例无 AP 和 4603 例有 AP 的患者。AP 患者年龄较大（68.1 岁比 65.2 岁，P<0.0001），女性居多（82.1%比 55.9%），Elixhauser 合并症指数（2.29 比 1.89，P<0.0001）显示合并症更多。AP 患者需要植骨的风险增加（优势比 [OR] = 47.97，95%置信区间 [CI]：14.27 至 161.22）、输血（OR = 1.90，95% CI：1.57 至 2.29）和 THA 后 90 天内发生假体周围骨折（OR = 2.56，95% CI：1.10 至 5.97）的风险更高。AP 患者的索引住院时间和费用更长（5.0 天比 4.3 天，P = 0.002；19211.88 美元比 27736.30 美元，P<0.0001）。
鉴于当前对医院成本优化的重视，确保 AP 患者得到适当的治疗非常重要。在这一人群中，应注意综合术前计划和术后监测。
