Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, M5G 1X5, Canada.
Int Orthop. 2022 Aug;46(8):1733-1740. doi: 10.1007/s00264-022-05437-7. Epub 2022 May 20.
Treatment of symptomatic developmental dysplasia of the hip (DDH) requires a technically demanding total hip arthroplasty (THA) reconstruction. In patients with DDH, prostheses can be difficult to implant and often face the risk of fracture, mismatch, and loosening. The Wagner Cone Prosthesis™ is a tapered, conical stem which can improve treatment success in this population. We look at midterm survivorship and outcomes of THA for DDH using the Wagner Cone Prosthesis™.
We retrospectively analyzed 28 patients (33 hips) with DDH undergoing THA using the Wagner Cone Prosthesis™ between January 2008 and January 2020. Ten, nine, and fourteen included patients were classified as Hartofilakidis A, B, and C, respectively. Survivorship according to Kaplan-Meier analysis was the primary outcome, with re-operation and revision as endpoints. The Oxford hip score (OHS) was used to assess clinical outcome. We used multivariate analysis to determine predictors of poor outcomes. The average follow-up was 4.6 years, with a minimum of two years.
Kaplan-Meier survivorship over the 13-year study period was 93.9 ± 4.2% for all-cause revision as an endpoint and 96.9 ± 3.1% for stem revisions only. The overall reoperation rate was 6.1%, with periprosthetic fracture and dislocation being reasons for re-operation. No patients were revised for aseptic loosening, and no patients were revised for subsidence. OHS improved from 19.3 ± 9.6 (4-39) pre-operatively to 37.6 ± 8.4 (19-48) at latest follow-up (p < 0.05).
In patients with DDH, THA with the Wagner Cone Prosthesis™ demonstrates excellent clinical, radiographic, and patient-reported functional outcomes at midterm follow-up.
有症状的发育性髋关节发育不良（DDH）的治疗需要技术要求很高的全髋关节置换术（THA）重建。在 DDH 患者中，假体植入可能很困难，并且经常面临骨折、不匹配和松动的风险。Wagner Cone 假体™是一种锥形、圆锥形的柄，可提高该人群的治疗成功率。我们研究了 Wagner Cone 假体™用于 DDH 的 THA 的中期生存率和结果。
我们回顾性分析了 2008 年 1 月至 2020 年 1 月期间接受 Wagner Cone 假体™THA 的 28 例（33 髋）DDH 患者。10、9 和 14 例患者分别被归类为 Hartofilakidis A、B 和 C。根据 Kaplan-Meier 分析的生存率是主要结果，以再手术和翻修为终点。使用牛津髋关节评分（OHS）评估临床结果。我们使用多变量分析来确定不良结果的预测因素。平均随访时间为 4.6 年，最短随访时间为 2 年。
在 13 年的研究期间，Kaplan-Meier 生存率为所有原因翻修为终点的 93.9%±4.2%，仅为柄翻修为终点的 96.9%±3.1%。总的再手术率为 6.1%，翻修原因包括假体周围骨折和脱位。没有患者因无菌性松动而翻修，也没有患者因下沉而翻修。OHS 从术前的 19.3±9.6（4-39）改善至末次随访时的 37.6±8.4（19-48）（p<0.05）。
在 DDH 患者中，Wagner Cone 假体™THA 在中期随访时具有出色的临床、影像学和患者报告的功能结果。
