Malhotra Rajesh, Batra Sahil, Sugumar PonAravindhan A, Gautam Deepak
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.
Bone Jt Open. 2022 Apr;3(4):314-320. doi: 10.1302/2633-1462.34.BJO-2022-0015.R1.
Adult patients with history of childhood infection pose a surgical challenge for total hip arthroplasty (THA) due to distorted bony anatomy, soft-tissue contractures, risk of reinfection, and relatively younger age. Therefore, the purpose of the present study was to determine clinical outcome, reinfection rate, and complications in patients with septic sequelae after THA.
A retrospective analysis was conducted of 91 cementless THAs (57 male and 34 female) performed between 2008 and 2017 in patients who had history of hip infection during childhood. Clinical outcome was measured using Harris Hip Score (HHS) and Modified Merle d'Aubigne and Postel (MAP) score, and quality of life (QOL) using 12-Item Short Form Health Survey Questionnaire (SF-12) components: Physical Component Score (PCS) and Mental Component Score (MCS); limb length discrepancy (LLD) and radiological assessment of the prosthesis was performed at the latest follow-up. Reinfection and revision surgery after THA for any reason was documented.
There was significant improvement in HHS, Modified Merle d'Aubigne Postel hip score, and QOL index SF 12-PCS and MCS (p < 0.001) and there was no case of reinfection reported during the follow-up. The minimum follow-up for the study was three years with a mean of 6.5 (SD 2.3; 3 to 12). LLD decreased from a mean of 3.3 cm (SD 1) to 0.9 cm (SD 0.8) during follow-up. One patient required revision surgery for femoral component loosening. Kaplan-Meier survival analysis estimated revision-free survivorship of 100% at the end of five years and 96.9% (95% confidence interval 79.8 to 99.6) at the end of ten years.
We found that cementless THA results in good to excellent functional outcomes in patients with a prior history of childhood infection. There is an exceedingly low rate of risk of reinfection in these patients, even though complications are not uncommon. Cite this article: 2022;3(4):314-320.
有儿童期感染病史的成年患者因骨骼解剖结构变形、软组织挛缩、再感染风险以及相对年轻等因素，给全髋关节置换术（THA）带来了手术挑战。因此，本研究的目的是确定THA术后有脓毒症后遗症患者的临床结局、再感染率和并发症。
对2008年至2017年间为有儿童期髋关节感染病史的患者进行的91例非骨水泥型THA手术（57例男性和34例女性）进行回顾性分析。使用Harris髋关节评分（HHS）和改良Merle d'Aubigne与Postel评分（MAP）评估临床结局，使用12项简短健康调查问卷调查表（SF-12）的身体成分评分（PCS）和精神成分评分（MCS）评估生活质量（QOL）；在最近一次随访时进行肢体长度差异（LLD）和假体的影像学评估。记录THA术后因任何原因导致的再感染和翻修手术情况。
HHS、改良Merle d'Aubigne Postel髋关节评分以及QOL指数SF 12-PCS和MCS均有显著改善（p < 0.001），随访期间未报告再感染病例。本研究最短随访时间为3年，平均为6.5年（标准差2.3；3至12年）。随访期间LLD从平均3.3厘米（标准差1）降至0.9厘米（标准差0.8）。1例患者因股骨部件松动需要翻修手术。Kaplan-Meier生存分析估计，5年末无翻修生存率为100%，10年末为 96.9%（95%置信区间79.8至99.6）。
我们发现，非骨水泥型THA在有儿童期感染病史的患者中可产生良好至优异的功能结局。这些患者的再感染风险极低，尽管并发症并不少见。引用本文：2022；3(4):314-320。
