Bose Vijay C, Pichai Suryanarayan, Ashok Kumar P S, Kanniyan Kalaivanan, Yadlapalli Subramanyam, Patil Shantanu
Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India.
SRM Medical College, SRM IST, Kattankulathur, Tamil Nadu India.
Indian J Orthop. 2021 Sep 5;55(5):1240-1249. doi: 10.1007/s43465-021-00505-3. eCollection 2021 Oct.
Traditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high. A move towards giving more importance to functional dynamic parameters rather than static anatomical parameters and less reliance on stability testing at trial reduction is warranted.
Intraoperative 3D functional balancing of THA without stability testing at trial reduction was practiced in all subjects undergoing THA in our unit from April 2014. To date 1019 patients have had their hips replaced with the same technique. They were followed up till April 2020 for post-operative complications of dislocation and significant LLD needing footwear modification. A secondary cohort of 114 patients from 1st January to December 31st 2017 within this primary group were analyzed clinically and radiologically to ascertain the implications of functional 3D balancing on X-ray parameters, clinical outcome scores (Harris Hip Score and Oxford Hip Score), ability to squat, and subtle subjective post-operative perception of limb lengthening (POPLL).
In the primary group of 1019 patients, there were only two dislocations and no patient needed footwear modification for LLD. In the detailed analysis of the secondary cohort of 114 patients, the correlation with restoration of static radiological parameters was inconsistent. 40 patients could not squat and 4 patients had subtle subjective post-operative perceived limb lengthening (POPLL). Measured outcomes such as HHS and OHS were improved in all patients with significant statistical significance ( < 0.001).
This study underlines the fact that more importance must be given to functional dynamic parameters by 3D balancing of the THA and not on static anatomical X-rays parameters and stability testing during trial reduction. This represents a paradigm shift in the evolution of total hip arthroplasty.
A Level II study. (Data collected from the ongoing prospective study) (http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf).
The online version contains supplementary material available at 10.1007/s43465-021-00505-3.
全髋关节置换术（THA）取得成功结果的传统原则很大程度上依赖于将髋臼放置在原位，并试图恢复通过X线或术中测量得出的静态解剖学股骨参数。传统上，通过在试复位时进行适当调整来实现稳定性。从生物力学角度来看，脱位和需要修改鞋具的明显肢体长度差异（LLD）等术后并发症代表了两个极端，而且这些并发症的发生率仍然相对较高。因此，有必要更加重视功能动态参数而非静态解剖学参数，并减少对试复位时稳定性测试的依赖。
自2014年4月起，我们单位对所有接受THA的患者在术中进行THA的3D功能平衡，且不进行试复位时的稳定性测试。截至目前，已有1019例患者采用相同技术进行了髋关节置换。对他们进行随访直至2020年4月，以观察脱位和需要修改鞋具的明显LLD等术后并发症情况。对该主要队列中2017年1月1日至12月31日期间的114例患者进行二次队列分析，从临床和影像学方面确定功能3D平衡对X线参数、临床结局评分（Harris髋关节评分和牛津髋关节评分）、下蹲能力以及术后肢体延长的细微主观感受（POPLL）的影响。
在1019例患者的主要队列中，仅发生了2例脱位，且没有患者因LLD需要修改鞋具。在对114例患者的二次队列进行详细分析时，与静态放射学参数恢复的相关性并不一致。40例患者无法下蹲，4例患者有术后肢体延长的细微主观感受（POPLL）。所有患者的测量结果如HHS和OHS均有改善，且具有显著统计学意义（<0.001）。
本研究强调了一个事实，即全髋关节置换术的3D平衡必须更加重视功能动态参数，而不是静态解剖学X线参数和试复位时的稳定性测试。这代表了全髋关节置换术发展中的一种范式转变。
二级研究。（数据来自正在进行的前瞻性研究）（http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf）。
在线版本包含可在10.1007/s43465-021-00505-3获取的补充材料。
