Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
Traumaplasty Melbourne, East Melbourne, Victoria, Australia.
J Bone Joint Surg Am. 2022 Jan 5;104(1):24-32. doi: 10.2106/JBJS.21.00487.
Compared with other total hip arthroplasty (THA) approaches, the anterior approach has an increased rate of revision for femoral-sided complications, and certain stems may increase this risk. The present study aimed to assess the outcome of THA by surgical approach, according to the femoral stem utilized in the procedure.
Data from the Australian Orthopaedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for osteoarthritis via the anterior or posterior approach with use of 1 of 5 of the most common cementless femoral stems from January 2015 to December 2019. The primary outcome measures were the cumulative percent revision (CPR) for all causes and for femoral stem loosening and fracture. The CPR was compared between THAs performed via the anterior and posterior approaches for all stems and for each individual femoral stem, as well as between individual femoral stems for each approach.
The study included 48,716 THAs performed with use of cementless stems, of which 22,840 utilized an anterior approach and 25,876 utilized a posterior approach. There was no difference in the all-cause CPR between the anterior and the posterior approach, but the anterior approach had a higher CPR for loosening (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.48 to 2.69; p < 0.001) and fracture (HR, 1.78; 95% CI, 1.34 to 2.35; p < 0.001). There was apparent variation in the CPR across the different cementless stems when an anterior approach was utilized. The Quadra-H (Medacta) had a higher all-cause CPR when compared with the Polarstem (Smith & Nephew; HR, 1.49; 95% CI, 1.16 to 1.91; p = 0.002) and Corail (DePuy Synthes; HR, 1.31; 95% CI, 1.00 to 1.70; p = 0.0478). Variation was less apparent with the posterior approach.
THAs performed via the anterior approach had higher rates of revision for femoral stem loosening and fracture, with greater variation in outcomes between individual stems.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
与其他全髋关节置换术（THA）方法相比，前路具有更高的股骨侧并发症翻修率，而某些柄可能会增加这种风险。本研究旨在根据手术中使用的股骨柄，评估不同手术入路的 THA 结果。
对 2015 年 1 月至 2019 年 12 月期间澳大利亚矫形协会国家关节置换登记处接受前路或后路初次 THA 治疗骨关节炎的患者数据进行分析，使用的是最常见的 5 种非骨水泥股骨柄中的 1 种。主要结局测量指标为所有原因、股骨柄松动和骨折的累积翻修率（CPR）。比较了所有柄和每种股骨柄的前路和后路 THA 的 CPR，以及每种入路的每种股骨柄的 CPR。
研究纳入了 48716 例使用非骨水泥柄的 THA，其中 22840 例采用前路，25876 例采用后路。前路和后路在所有原因的 CPR 方面没有差异，但前路在松动（危险比 [HR]，2.00；95%置信区间 [CI]，1.48 至 2.69；p<0.001）和骨折（HR，1.78；95% CI，1.34 至 2.35；p<0.001）方面的 CPR 更高。当采用前路时，不同非骨水泥柄的 CPR 明显不同。与 Polarstem（Smith & Nephew）相比，Quadra-H（Medacta）的所有原因 CPR 更高（HR，1.49；95%CI，1.16 至 1.91；p=0.002）和 Corail（DePuy Synthes）（HR，1.31；95%CI，1.00 至 1.70；p=0.0478）。后路的变化不那么明显。
前路 THA 的股骨柄松动和骨折翻修率较高，不同柄之间的结果差异较大。
治疗性 III 级。请参阅作者说明以获取完整的证据水平描述。
