Tay Kenny, Tang Andrew, Fary Camdon, Patten Sam, Steele Robert, de Steiger Richard
Arthroplasty Fellow, Epworth Musculoskeletal Clinical Institute, 89 Bridge Road, Richmond, Melbourne, VIC, 3121, Australia.
Present Address: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Arthroplasty. 2019 Sep 3;1(1):5. doi: 10.1186/s42836-019-0008-2.
Total hip arthroplasty (THA) is traditionally associated with a low complication rate, with complications such as infection, fracture and dislocation requiring readmission or reoperation. We seek to identify the complication rate among the anterior, direct lateral and posterior surgical approaches.
We reviewed all THAs performed at the Epworth Healthcare from 1 July 2014 to 30 June 2016. There were 2437 THAs performed by a variety of approaches. No hips were excluded from this study. We surveyed the hospital database and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to identify those patients who had been readmitted and/or reoperated on. Details collected included age, gender, laterality of the surgery (left/right/bilateral), surgical approach utilised, complications which occurred.
There were 29 peri-prosthetic fractures detected (13 anterior, 9 lateral, 7 posterior) and 10 underwent revision of implant, 19 were fixed. The increased rate of revision in the anterior group was statistically significant. There were 14 dislocations (5 anterior, 1 lateral, 8 posterior) of which 8 prostheses were revised. Three cases operated via the anterior approach and 1 by the lateral had early subsidence without fracture, necessitating revision of the femoral prostheses. Operative site infection occurred in 12 cases (2 anterior, 4 lateral, 6 posterior) with 6 requiring revision of implants.
The complication rates between the 3 main approaches are similar, but individual surgeons should be vigilant for complications unique to their surgical approaches, such as femoral fractures in the anterior approach and dislocations in the posterior approach.
传统上，全髋关节置换术（THA）的并发症发生率较低，感染、骨折和脱位等并发症需要再次入院或再次手术。我们旨在确定前路、直接外侧和后路手术入路的并发症发生率。
我们回顾了2014年7月1日至2016年6月30日在Epworth医疗中心进行的所有全髋关节置换术。通过各种入路共进行了2437例全髋关节置换术。本研究未排除任何髋关节。我们调查了医院数据库和澳大利亚骨科协会国家关节置换登记处（AOANJRR），以确定那些再次入院和/或接受再次手术的患者。收集的详细信息包括年龄、性别、手术侧别（左/右/双侧）、采用的手术入路、发生的并发症。
共检测到29例假体周围骨折（13例前路，9例外侧，7例后路），其中10例进行了假体翻修，19例进行了固定。前路组翻修率的增加具有统计学意义。共发生14例脱位（5例前路，1例外侧，8例后路），其中8例假体进行了翻修。3例经前路手术和1例经外侧手术的患者出现早期下沉但无骨折，需要翻修股骨假体。手术部位感染发生12例（2例前路，4例外侧，6例后路），其中6例需要翻修植入物。
三种主要手术入路的并发症发生率相似，但个别外科医生应警惕其手术入路特有的并发症，如前路的股骨骨折和后路的脱位。
