Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chineses Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Orthop Surg. 2023 Apr;15(4):1037-1044. doi: 10.1111/os.13685. Epub 2023 Feb 21.
Poliomyelitis is a rare neuromuscular disease that can cause hip osteoarthritis on the contralateral side due to an abnormal mechanical weight-bearing state, making some residual poliomyelitis patients candidates for total hip arthroplasty (THA). The aim of this study was to investigate the clinical outcome of THA in the nonparalytic limbs of these patients compared with those of non-poliomyelitis patients.
Patients treated between January 2007 and May 2021 were retrospectively identified in a single center arthroplasty database. Eight residual poliomyelitis cases that met the inclusion criteria were matched to non-poliomyelitis cases in a ratio of 1:2 based on age, sex, body mass index (BMI), age-adjusted Charlson comorbidity index (aCCI), surgeon, and operation date. The hip function, health-related quality of life, radiographic outcomes, and complications were analyzed with unpaired Student's t test, Mann-Whitney test, Fisher's exact test or analysis of covariance (ANCOVA). Survivorship analysis was determined using the Kaplan-Meier estimator analysis and Gehan-Breslow-Wilcoxon test.
After a mean follow-up of about 5 years, patients with residual poliomyelitis had worse postoperative mobility outcomes(P < 0.05), but there was no difference in total modified Harris hip score (mHHS) or European quality of life-visual analogue scale (EQ-VAS) between the two groups (P > 0.05). There was no difference in radiographic outcomes or complications between the two groups, and patients had similar postoperative satisfaction (P > 0.05). No readmission or reoperation occurred in the poliomyelitis group (P > 0.05), but the postoperative limb length discrepancy (LLD) in the residual poliomyelitis group was greater than that in the control group (P < 0.05).
Functional outcomes, health-related quality of life improvement were similarly significantly improved in the nonparalytic limb of residual poliomyelitis patients after THA compared with conventional osteoarthritis patients. However, the residual LLD and weak muscle strength of the affected side will still influence mobility, so residual poliomyelitis patients should be fully informed of this outcome before surgery.
脊髓灰质炎是一种罕见的神经肌肉疾病，由于异常的机械承重状态，可能会导致对侧髋关节骨关节炎，使一些残留脊髓灰质炎患者成为全髋关节置换术（THA）的候选者。本研究旨在探讨这些患者非瘫痪肢体接受 THA 的临床效果，并与非脊髓灰质炎患者进行比较。
我们在单中心关节置换数据库中回顾性地确定了 2007 年 1 月至 2021 年 5 月期间接受治疗的患者。根据年龄、性别、体重指数（BMI）、年龄调整 Charlson 合并症指数（aCCI）、手术医生和手术日期，我们从符合纳入标准的 8 例残留脊髓灰质炎病例中匹配了非脊髓灰质炎病例，比例为 1:2。采用配对学生 t 检验、Mann-Whitney 检验、Fisher 精确检验或协方差分析（ANCOVA）分析髋关节功能、健康相关生活质量、影像学结果和并发症。采用 Kaplan-Meier 估计分析和 Gehan-Breslow-Wilcoxon 检验进行生存分析。
在平均约 5 年的随访后，残留脊髓灰质炎患者的术后活动度较差（P<0.05），但两组之间的总改良 Harris 髋关节评分（mHHS）或欧洲生活质量视觉模拟量表（EQ-VAS）无差异（P>0.05）。两组的影像学结果或并发症无差异，且患者的术后满意度相似（P>0.05）。脊髓灰质炎组无再入院或再手术（P>0.05），但残留脊髓灰质炎组的术后肢体长度差异（LLD）大于对照组（P<0.05）。
与常规骨关节炎患者相比，THA 后残留脊髓灰质炎患者的非瘫痪肢体的功能结果和健康相关生活质量的改善同样显著。然而，患侧残留的肢体长度差异和肌力较弱仍会影响活动能力，因此在手术前应充分告知残留脊髓灰质炎患者这一结果。
