Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.
Department of Orthopaedic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio.
J Arthroplasty. 2024 Jan;39(1):180-186. doi: 10.1016/j.arth.2023.07.019. Epub 2023 Jul 31.
Evidence on the effects of time-to-failure from primary total hip arthroplasty (THA) to aseptic first-revision on clinical results and patient-reported outcome measures (PROMs) is scarce. Therefore, we sought to compare demographics, operative times, lengths of stay, discharge dispositions, 90-day readmissions, re-revision rates, mortalities, and PROMs between early and late aseptic THA revisions.
This study is a retrospective review of a prospectively collected institutional database of all elective hip procedures. In total, 572 patients who underwent aseptic revision after primary THA from August 2015 to December 2018 were analyzed. Patients were stratified into either early revision (<3-years; n = 176) or late revision (≥3-years; n = 396) cohorts.
Significantly more patients were revised earlier for bone-related (ie, periprosthetic fractures) (22.7% versus 8.3%) or other various complications (19.9% versus 5.8%), whereas more late revisions were performed to treat implant-related failures (6.8% versus 37.1%), respectively. Operative time was significantly shorter in early versus late revisions (133 versus 157 minutes). A significantly higher delta-change/improvement from baseline/preoperative to 1-year postoperative was found for hip disability and osteoarthritis outcome score physical function (HOOS-PS), veterans-RAND-12 physical and mental components (VR-12-PCS and MCS, respectively) of early revisions. However, HOOS-PS and HOOS-Pain at 1-year of follow-up were significantly worse in early revisions.
With exception of operative time, time-to-failure had no significant influence on clinical results. Despite greater improvements on PROMs from preoperative to postoperative, patients undergoing early revisions after primary THA perceive significantly higher levels of pain and worse physical functionality at 1-year of follow-up.
关于初次全髋关节置换术（THA）后至无菌初次翻修的失败时间对临床结果和患者报告的结局测量（PROM）的影响的证据很少。因此，我们试图比较早期和晚期无菌 THA 翻修之间的人口统计学、手术时间、住院时间、出院情况、90 天再入院率、再翻修率、死亡率和 PROM。
本研究是对 2015 年 8 月至 2018 年 12 月期间所有择期髋关节手术的前瞻性收集的机构数据库的回顾性分析。共分析了 572 例初次 THA 后无菌翻修的患者。患者分为早期翻修（<3 年；n=176）或晚期翻修（≥3 年；n=396）组。
早期翻修的患者中，因骨相关（即假体周围骨折）（22.7%对 8.3%）或其他各种并发症（19.9%对 5.8%）而更早翻修的患者明显更多，而晚期翻修的患者则因植入物相关失败（6.8%对 37.1%）而更多。早期翻修的手术时间明显短于晚期翻修（133 分钟对 157 分钟）。早期翻修的髋关节残疾和骨关节炎结局评分躯体功能（HOOS-PS）、退伍军人 RAND-12 躯体和精神成分（VR-12-PCS 和 MCS）从基线/术前到 1 年术后的改善幅度明显更高。然而，早期翻修的 HOOS-PS 和 HOOS-疼痛在 1 年随访时明显更差。
除手术时间外，失败时间对临床结果没有显著影响。尽管从术前到术后 PROM 有更大的改善，但初次 THA 后行早期翻修的患者在 1 年随访时疼痛水平更高，躯体功能更差。
