Chen Chin-Hsi, Okuzu Yaichiro, Goto Koji, Kuroda Yutaka, Kawai Toshiyuki, Matsuda Shuichi
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
J Exp Orthop. 2023 May 24;10(1):53. doi: 10.1186/s40634-023-00618-8.
Total hip arthroplasty (THA) is increasingly performed in older adults, and the prevalence of vertebral compression fracture (VCF) increases with age. We aimed to investigate the clinical outcomes of THA in patients with VCF.
We reviewed the records of 453 patients who underwent THA at our institution between 2015 and 2021. We classified patients into those with and without VCF. VCF was identified using preoperative upright whole-spine radiographs. Spinal parameters, preoperative and 1-year postoperative clinical outcomes of the Harris hip score (HHS), Oxford hip score (OHS), and visual analog scale (VAS) for low back pain (LBP) were assessed. Furthermore, propensity score-matched cohorts for age, sex, body mass index, and spinal parameters were created, and the clinical outcomes were compared between the two groups.
Among the 453 patients, 51 (11.3%) with VCF and 402 without VCF were identified. Before matching, patients with VCF were older (p < 0.01), had sagittal spinal imbalance (p < 0.01), and had worse clinical outcomes pre- and postoperatively. After matching 47 patients in both groups, patients with VCF had worse HHS (p < 0.05), especially regarding support and distance walked, and worse VAS scores for LBP (p < 0.05) pre- and postoperatively. However, the improvements in scores were not significantly different between the groups.
HHS, especially regarding support and distance walked, and VAS scores for LBP were poorer in patients with VCF preoperatively and 1-year postoperatively. Our findings suggest that hip surgeons should evaluate not only spinal alignment but also the presence of VCF before performing THA.
Level III, Retrospective cohort study.
全髋关节置换术（THA）在老年人中越来越普遍，而椎体压缩骨折（VCF）的患病率随年龄增长而增加。我们旨在研究THA治疗VCF患者的临床疗效。
我们回顾了2015年至2021年在本机构接受THA的453例患者的记录。我们将患者分为有VCF和无VCF两组。通过术前站立位全脊柱X线片确定VCF。评估脊柱参数、术前和术后1年的Harris髋关节评分（HHS）、牛津髋关节评分（OHS）以及腰痛视觉模拟量表（VAS）的临床疗效。此外，创建了年龄、性别、体重指数和脊柱参数的倾向评分匹配队列，并比较两组的临床疗效。
在453例患者中，确定有51例（11.3%）有VCF，402例无VCF。匹配前，有VCF的患者年龄更大（p < 0.01），存在矢状面脊柱失衡（p < 0.01），术前和术后的临床疗效更差。两组各匹配47例患者后，有VCF的患者HHS更差（p < 0.05），尤其是在支撑和行走距离方面，术前和术后腰痛的VAS评分也更差（p < 0.05）。然而，两组评分的改善情况无显著差异。
有VCF的患者术前和术后1年的HHS，尤其是支撑和行走距离方面，以及腰痛的VAS评分较差。我们的研究结果表明，髋关节外科医生在进行THA之前，不仅应评估脊柱排列，还应评估VCF的存在情况。
III级，回顾性队列研究。
