Ng Mitchell K, Kobryn Andriy, Golub Ivan J, Piuzzi Nicolas S, Wong Che Hang Jason, Jones Lynne, Mont Michael A
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, 11203, USA.
Arthroplasty. 2023 May 1;5(1):23. doi: 10.1186/s42836-023-00176-5.
The incidence of osteonecrosis of the femoral head is estimated at about 10 to 20,000 patients annually, and, when left untreated, 80% or more of cases progress to femoral head collapse. A series of joint-preserving procedures have been developed to prevent/delay the need for hip arthroplasty. The aim of this study was to provide a five-year update: (1) evaluating temporal trends of arthroplasty vs. joint-preservation techniques such as core decompression, bone grafting, osteotomies, and arthroscopy; (2) determining proportions of procedures in patients aged less than vs. over 50 years; and (3) quantifying rates of specific operative techniques.
A total of 10,334 patients diagnosed with osteonecrosis of the femoral head and having received hip surgery were identified from a nationwide database between 1 January 2010 and 31 December 2019, by using the International Classification of Disease, the Ninth/Tenth revision (ICD-9/10) codes. The percentage of patients managed by each operative procedure was calculated annually. To identify trends, patients were grouped by age under/over 50 years and divided into a joint-preserving and a non-joint-preserving (arthroplasty) group. Chi-squared tests were performed to compare the total number of procedures per year.
Rates of arthroplasty far exceeded those for joint-preserving procedures. However, from 2015 to 2019, significantly more joint-preserving procedures were performed than in 2010 to 2014 (4.3% vs. 3.0%, P < 0.001). Significantly more joint-preserving procedures were performed in patients aged < 50 years relative to those ≥ 50 years (7.56% vs. 1.86%, P < 0.001). Overall, total hip arthroplasty was the most common procedure (9,814; 94.97%) relative to core decompression (331; 3.20%), hemiarthroplasty/resurfacing (102; 0.99%), bone grafting (48; 0.46%), and osteotomy (5; 0.05%).
Management of patients who have osteonecrosis of the femoral head continues to be predominantly arthroplasty procedures, specifically, total hip arthroplasty. Our findings suggest a small, but significant trend toward increased joint-preserving procedures, especially in patients under 50 years. In particular, the proportion of patients receiving core decompression has increased significantly from 2015 to 2019 relative to prior years.
据估计，股骨头坏死的年发病率约为10000至20000例患者，若不进行治疗，80%或更多的病例会发展为股骨头塌陷。已开发出一系列保关节手术以预防/推迟髋关节置换术的需求。本研究的目的是提供一份五年期更新报告：（1）评估关节置换术与保关节技术（如髓芯减压、骨移植、截骨术和关节镜检查）的时间趋势；（2）确定50岁以下与50岁以上患者的手术比例；（3）量化特定手术技术的发生率。
通过使用国际疾病分类第九/十版（ICD - 9/10）编码，从2010年1月1日至2019年12月31日的全国数据库中识别出总共10334例被诊断为股骨头坏死并接受髋关节手术的患者。每年计算每种手术方式治疗的患者百分比。为了确定趋势，将患者按年龄分为50岁以下/50岁以上两组，并分为保关节组和非保关节（关节置换术）组。进行卡方检验以比较每年手术的总数。
关节置换术的发生率远远超过保关节手术。然而，从2015年到2019年，进行的保关节手术明显多于2010年到2014年（4.3%对3.0%，P＜0.001）。50岁以下患者进行的保关节手术明显多于≥50岁的患者（7.5%对1.86%，P＜0.001）。总体而言，全髋关节置换术是最常见的手术（9814例；94.97%），相对于髓芯减压（331例；3.20%）、半髋关节置换术/表面置换术（102例；0.99%）、骨移植（48例；0.46%）和截骨术（5例；0.05%）。
股骨头坏死患者的治疗仍主要采用关节置换术，特别是全髋关节置换术。我们的研究结果表明，保关节手术有一个虽小但显著的增加趋势，尤其是在50岁以下的患者中。特别是，相对于前几年，2015年到2019年接受髓芯减压的患者比例显著增加。
