Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China.
The Department of Clinical Medicine, Fujian Medical University, Fuzhou, China.
BMC Musculoskelet Disord. 2023 Apr 22;24(1):319. doi: 10.1186/s12891-023-06409-7.
To investigate whether the application of a curved rasp on the femoral side is effective in reducing the incidence of stem malalignment in total hip replacement with direct anterior approach (DAA-THA), followed by the analysis of the independent risk factors affecting stem malalignment.
Retrospective analysis was carried out covering 160 patients undergoing DAA-THA from January 2019 to December 2021, with Tri-Lock (BPS, Depuy) stem applied in all 113 patients were screened according to inclusion and exclusion criteria. The data of gender, age, body mass index, preoperative diagnoses, Dorr classification, FAR ratio, pelvic morphology ratio, WOMAC scores, were analyzed to explore the independent factors influencing the malalignment of the femoral prosthesis implantation. Then data of patients were divided into group A and group B according to whether the curved rasp was taken during the operation. The chi-square test was performed to compare the incidence of femoral stem malalignment between the two groups.
There revealed two independent risk factors: BMI and FAR ratio that affected femoral stem malalignment. The increased BMI was associated with a higher probability of femoral stem malalignment (P<0.05), the probability of malalignment of femoral stem in FAR ratio<1 was 1.15 times higher than that in FAR>1(OR = 1.15, 95% CI: 1.03-1.28, P<0.05). Further grouping analysis showed that the incidence of femoral stem malalignment in patients with intraoperative application of curved rasp was 27%, while in patients without curved rasp, the incidence of femoral stem malalignment increased significantly to 48.7%(P<0.05). The placement angle of prosthesis in group A was significantly better than that in group B, especially mild femoral stem malalignment (0%) and severe femoral stem malalignment (2.70%), and the difference was statistically significant (P < 0.05). There found no significant difference in age, gander, intraoperative complications and last follow-up assessment of WOMAC scores between the two groups of patients.
In DAA-THA, BMI and FAR ratio act as the independent risk factors for femoral stem malalignment. Intraoperative use of a curved rasp significantly reduces the incidence of malalignment of the femoral stem.
探讨在直接前入路（DAA-THA）全髋关节置换术中应用股骨侧弯锉是否能降低股骨假体对线不良的发生率，并分析影响股骨假体对线不良的独立危险因素。
回顾性分析 2019 年 1 月至 2021 年 12 月采用 DAA-THA 治疗的 160 例患者，根据纳入和排除标准筛选出所有 113 例应用 Tri-Lock（BPS，Depuy）股骨柄的患者。分析患者的性别、年龄、体重指数、术前诊断、Dorr 分型、FAR 比值、骨盆形态比、WOMAC 评分等数据，探讨影响股骨假体植入对线不良的独立因素。然后根据术中是否使用弯锉将患者分为 A 组和 B 组，采用卡方检验比较两组股骨柄对线不良的发生率。
BMI 和 FAR 比值是影响股骨假体对线不良的两个独立危险因素。BMI 增加与股骨柄对线不良的概率更高相关（P<0.05），FAR 比值<1 的股骨柄对线不良的概率是 FAR>1 的 1.15 倍（OR=1.15，95%CI：1.03-1.28，P<0.05）。进一步分组分析显示，术中应用弯锉的患者股骨柄对线不良发生率为 27%，而未应用弯锉的患者股骨柄对线不良发生率显著增加至 48.7%（P<0.05）。A 组患者假体的放置角度明显优于 B 组，尤其是轻度股骨柄对线不良（0%）和重度股骨柄对线不良（2.70%），差异具有统计学意义（P<0.05）。两组患者的年龄、性别、术中并发症和末次随访 WOMAC 评分评估无明显差异。
在 DAA-THA 中，BMI 和 FAR 比值是股骨假体对线不良的独立危险因素。术中应用弯锉可显著降低股骨柄对线不良的发生率。
