Man Lok-Chun, Yeung Yip-Kan, Ho Sheung-Tung, Chiu Ming-Yu, Pan Nin-Yuan
Department of Orthopaedics and Traumatology, Caritas Medical Centre, 111 Wing Hong Street, Hong Kong, China.
Department of Radiology, Caritas Medical Centre, 111 Wing Hong Street, Hong Kong, HKSAR, China.
Arthroplasty. 2022 Feb 3;4(1):5. doi: 10.1186/s42836-021-00107-2.
The study aimed to establish quantitative diagnostic criteria for rapidly progressive osteoarthritis (RPOA) of the hip and to compare the criteria with those for other pathological hip entities in the Asian population.
From July 2011 to September 2019, 126 patients who had undergone hip replacement were retrospectively recruited from a fast-track joint replacement list. Patient demographics and radiological parameters were evaluated. Diagnosis of hip RPOA was established based on Lequesne et al's criteria. The patients with RPOA, hip dysplasia, avascular necrosis, and primary osteoarthritis were allocated to the corresponding groups separately and compared. The diagnostic criteria of RPOA were established and validated in the sample population.
Diagnosis of hip RPOA was confirmed in 18 patients. Their mean age at surgery (72 years) was significantly higher in this group than in the dysplasia and avascular necrosis groups. The mean pelvic tilt parameter (0.485) of RPOA group was significantly lower than those of other groups. The mean initial Tonnis angle (8.35°) of RPOA group was significantly higher than those of avascular necrosis and osteoarthritis groups. The differences were statistically significant between RPOA and non-RPOA groups in limb shortening rate, superior joint space narrowing, acetabular destruction, and head destruction (P < 0.05). Tonnis angle and lateral subluxation also increased significantly during the disease progression.
Posterior pelvic tilt and increased Tonnis angle may contribute to the pathogenesis of RPOA, leading to progressive acquired acetabular obliquity and lateral subluxation. We propose the modern comprehensive diagnostic criteria be based on the existing literature and the current findings. Further external validation is recommended.
本研究旨在建立髋关节快速进展性骨关节炎（RPOA）的定量诊断标准，并将该标准与亚洲人群中其他病理性髋关节疾病的诊断标准进行比较。
从2011年7月至2019年9月，从快速关节置换名单中回顾性招募了126例接受髋关节置换的患者。评估患者的人口统计学特征和放射学参数。基于勒凯斯内等人的标准对髋关节RPOA进行诊断。将RPOA、髋关节发育不良、股骨头缺血性坏死和原发性骨关节炎患者分别归入相应组并进行比较。在样本人群中建立并验证RPOA的诊断标准。
18例患者被确诊为髋关节RPOA。该组患者的平均手术年龄（72岁）显著高于发育不良和股骨头缺血性坏死组。RPOA组的平均骨盆倾斜参数（0.485）显著低于其他组。RPOA组的平均初始托尼角（8.35°）显著高于股骨头缺血性坏死组和骨关节炎组。RPOA组与非RPOA组在肢体短缩率、上关节间隙变窄、髋臼破坏和股骨头破坏方面存在显著差异（P＜0.05）。在疾病进展过程中，托尼角和外侧半脱位也显著增加。
骨盆后倾和托尼角增加可能是RPOA发病机制的一部分，导致获得性髋臼倾斜和外侧半脱位逐渐加重。我们建议根据现有文献和当前研究结果制定现代综合诊断标准。建议进一步进行外部验证。
