La Paz University Hospital, Pso. Castellana 261, 28046, Madrid, Spain.
Int Orthop. 2022 Dec;46(12):2785-2791. doi: 10.1007/s00264-022-05536-5. Epub 2022 Aug 9.
The most frequent indication for total hip arthroplasty (THA) in adolescent patients has been juvenile idiopathic arthritis (JIA). However, in recent years, other causes have become more prevalent.
QUESTIONS/PURPOSES: (1) What is the survivorship following THA across the diagnostic spectrum in adolescent population? (2) How are quality of life results affected by systemic medical conditions?
We retrospectively reviewed all consecutive THA in patients under 21 years of age, performed at our Institution between 1993 and 2018. There were 34 prostheses implanted in 26 patients with a mean age of 18.4 years (range 11 to 21). The most frequent diagnosis was JIA (14 hips), followed by avascular necrosis (10 hips). Patient reported outcomes were assessed using Harris and Oxford Hip Scores (HHS and OHS), Visual Analogue Scale (VAS) and EuroQol-5D. Survivorship for revision and aseptic loosening was determined with Kaplan Meier analysis.
At final follow-up, the overall survival rate was of 89.3% at 12-year follow-up. Three acetabular components underwent revision surgery for aseptic loosening. Clinical HHS significantly improved from 37.5 to 90.6 points (p < 0.001). Mean OHH was 37.4 points, with a final VAS of 1.64 points. Mean 5Q-5D was 0.704 with an interquartile range of 0.4 to 1.0. JIA patients displayed worse pre-operative HHS scores, and at final follow-up had worse HHS, OHS, VAS and EQ-5D scores compared to the rest of the patients. Complications included three intra-operative femoral fractures, one sciatic nerve palsy and one adductor contracture.
THA in adolescent patients provides improved functional outcomes with acceptable revision rates at mid-term follow-up.
青少年全髋关节置换术（THA）最常见的适应证是幼年特发性关节炎（JIA）。然而，近年来，其他原因变得更为普遍。
问题/目的：（1）在青少年人群中，整个诊断谱系的 THA 生存率是多少？（2）全身医疗状况如何影响生活质量结果？
我们回顾性分析了 1993 年至 2018 年期间在我院接受治疗的年龄在 21 岁以下的所有连续 THA 病例。26 名患者（平均年龄 18.4 岁，范围 11 至 21 岁）共植入 34 个假体。最常见的诊断是 JIA（14 髋），其次是股骨头坏死（10 髋）。采用 Harris 和 Oxford 髋关节评分（HHS 和 OHS）、视觉模拟评分（VAS）和 EuroQol-5D 评估患者报告的结果。采用 Kaplan-Meier 分析确定翻修和无菌性松动的生存率。
在最终随访时，12 年随访时的总生存率为 89.3%。3 个髋臼组件因无菌性松动而行翻修手术。临床 HHS 从 37.5 显著改善至 90.6 分（p<0.001）。平均 OHH 为 37.4 分，最终 VAS 为 1.64 分。平均 5Q-5D 为 0.704，四分位距为 0.4 至 1.0。JIA 患者术前 HHS 评分较差，在最终随访时，HHS、OHS、VAS 和 EQ-5D 评分均较其他患者差。并发症包括 3 例术中股骨骨折、1 例坐骨神经麻痹和 1 例内收肌挛缩。
青少年患者的 THA 可提供更好的功能结果，中期随访时翻修率可接受。
