George Rahul, Chandy V J, Christudoss A I, Hariharan T D, ArunShankar A, Antonisamy B, Oommen A T, Poonnoose Pradeep Mathew
Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India.
Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632002 India.
Indian J Orthop. 2021 Aug 9;55(5):1232-1239. doi: 10.1007/s43465-021-00474-7. eCollection 2021 Oct.
This study aims to assess the risks and peri-operative morbidity associated with a single-stage sequential bilateral hip arthroplasty (SBHA) when performed in patients with arthritis secondary to inflammatory arthropathy.
Data of patients who underwent SBHA between 2012 and 2018 for inflammatory arthritis were extracted from a database, for peri-operative complications and functional improvement. SBHA for other causes was excluded.
Data of 84 consecutive patients with a mean age of 34.5 years were analyzed. The mean follow-up was 2.4 years. 66% had ankylosing spondylitis, while 14% had rheumatoid arthritis. 50% of the patients had bilateral fusion of the hips, and 34% had flexion deformity > 30°.None of the patients had peri-operative cardiac or pulmonary complications. 2.4% had per-operative hypotension (MAP < 50 mmHg) and 1.2% had desaturation (SpO < 90%). The mean drop in hematocrit was 9.3%. While 31% did not require blood transfusion, 35% required more than 1 unit of blood. Patients with pre-operative PCV of > 36% had a significantly lower risk of being transfused > 1 unit of blood ( = 0.02). ICU admission was 6%-mostly for post-operative monitoring. While one patient had a local hematoma that needed a wash-out, there were no infections, dislocations, or mortality in these patients. The modified Harris hip score improved from a mean of 26.5-85. The mean hip flexion improved post-operatively from 32° to 92°.
SBHA for inflammatory arthritis can be performed with minimum complications in a multidisciplinary setting. Pre-operatively, PCV of > 36 is advised to reduce transfusion rates.
本研究旨在评估炎性关节病继发关节炎患者进行单阶段序贯双侧髋关节置换术（SBHA）时的风险及围手术期发病率。
从数据库中提取2012年至2018年因炎性关节炎接受SBHA患者的数据，以分析围手术期并发症及功能改善情况。排除因其他原因进行的SBHA。
分析了84例连续患者的数据，平均年龄34.5岁。平均随访2.4年。66%患有强直性脊柱炎，14%患有类风湿关节炎。50%的患者双侧髋关节融合，34%有大于30°的屈曲畸形。所有患者均无围手术期心脏或肺部并发症。2.4%的患者术中出现低血压（平均动脉压<50mmHg），1.2%出现血氧饱和度下降（SpO<90%）。血细胞比容平均下降9.3%。31%的患者无需输血，35%的患者需要超过1单位血液。术前红细胞压积>36%的患者输注超过1单位血液的风险显著较低（P=0.02）。重症监护病房（ICU）入住率为6%，主要是为了术后监测。虽然有1例患者出现局部血肿需要冲洗，但这些患者中无感染、脱位或死亡情况。改良Harris髋关节评分从平均26.5分提高到85分。术后平均髋关节屈曲度从32°提高到92°。
在多学科环境下，炎性关节炎患者进行SBHA可将并发症降至最低。术前建议红细胞压积>36%以降低输血率。
