Teimouri Mehdi, Motififard Mehdi, Lalehzar Sahar Sadat, Hatami Saeed, Raeisi Sina
Department of Orthopedic Surgery, School of Medicine, Isfahan, Iran.
Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2022 Sep 27;27:70. doi: 10.4103/jrms.jrms_959_21. eCollection 2022.
Complications after primary total hip arthroplasty (THA) are the most common reason for revision. Due to the high prevalence of revision surgery, we investigated the frequency of postprimary THA complications and related risk factor revision surgery.
This is a cohort study that was performed in 2011-2019 on all patients who underwent primary THA surgery re-admitted to the Kashani and Saadi Hospital affiliated to Isfahan University of Medical Science, Iran, due to some complications after THA. Demographic and basic data were collected from patient's medical documents. Harris hip score (HHS) was calculated for all patients 6 months after the last surgery. The obtained data were analyzed using SPSS software version 21. Appropriate statistical tests were conducted to compare the results between the study groups.
Among 1260 patients who underwent primary THA, 1006 of them entered the study after applying the exclusion criteria. Thirty nine patients were under revision, 53.8% had prosthesis infection, 56.4% had instability, 6% had aseptic loosening, and 30.8% had periprosthetic fracture. Odds ratio for the above complications were 45.5, 45, 6.4, and 15.5, respectively. HHS postoperatively was also significantly ( < 0.001) higher in patients without revision. No correlation between gender or surgeon experience and revision was detected; however wound discharge ( < 0.001), body mass index (BMI) ( = 0.003), and Infection during hospitalization ( < 0.001) affect revision rate significantly. All four postsurgery complications, i.e., instability, postoperative prothesis infections, periprosthetic fractures, and aseptic loosening, significantly increased the risk of revision ( < 0.001, for all).
Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening were the most common causes for increasing revision rates after THA, respectively. Higher BMI, persistent wound discharge, and nosocomial infections during the first hospitalization also increased the rate of revision after primary THA.
初次全髋关节置换术（THA）后的并发症是翻修手术最常见的原因。由于翻修手术的高发生率，我们调查了初次THA后并发症的发生频率以及翻修手术的相关危险因素。
这是一项队列研究，于2011年至2019年对所有因THA后出现某些并发症而再次入住伊朗伊斯法罕医科大学附属卡沙尼医院和萨阿迪医院的初次THA手术患者进行。从患者的医疗文件中收集人口统计学和基本数据。在最后一次手术后6个月为所有患者计算Harris髋关节评分（HHS）。使用SPSS 21版软件对获得的数据进行分析。进行了适当的统计检验以比较研究组之间的结果。
在1260例行初次THA的患者中，1006例在应用排除标准后进入研究。39例患者接受了翻修手术，其中53.8%发生假体感染，56.4%出现不稳定，6%发生无菌性松动，30.8%发生假体周围骨折。上述并发症的比值比分别为45.5、45、6.4和15.5。未接受翻修的患者术后HHS也显著更高（<0.001）。未检测到性别或外科医生经验与翻修之间的相关性；然而，伤口引流（<0.001）、体重指数（BMI）（=0.003）和住院期间感染（<0.001）对翻修率有显著影响。所有四种术后并发症，即不稳定、术后假体感染、假体周围骨折和无菌性松动，均显著增加了翻修风险（所有P<0.001）。
不稳定、假体感染、假体周围骨折和无菌性松动分别是THA后翻修率增加的最常见原因。较高的BMI、持续的伤口引流以及首次住院期间的医院感染也增加了初次THA后的翻修率。
