IRCCS Policlinico San Martino, Clinica Ortopedica, DISC, Genova, Italy.
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
Int Orthop. 2024 Apr;48(4):931-943. doi: 10.1007/s00264-023-06067-3. Epub 2023 Dec 21.
There has been a growing interest in pathologic spine-hip relations (PSHR) in current literature, with the aim of reducing the risk of prosthetic impingement, dislocation, and edge loading in total hip arthroplasty (THA). The primary objective of this review is to determine the effect of different PSHR on primary THA outcomes and complication profile. The secondary objective is to stratify the risk of different subgroups of PSHR patients.
A systematic review of the literature was performed in accordance with PRISMA guidelines. Randomised controlled trials, comparative cohort studies and case-control studies comparing outcomes and complication rates of primary THA in patients with and without a PSHR (spinal fusion; degenerative spinal conditions determining stiff spine and/or spinal misalignment) were included. The quality of the included studies and the risk of bias were assessed. The revision rate, complications, and clinical and radiological data were analysed. Complications included: aseptic loosening (AL), periprosthetic joint infections (PJI), hip dislocations and periprosthetic fractures (PF).
Fifteen articles were included with 3.306.342 THAs. The mean follow-up (FU) was 31.4 ± 21.7 months. The population was divided into three subgroups: spinal fusion patients (48.315 THAs); non-fused patients with spinal stiffness (106.110 THAs); non-fused patients with normal spines (3.151.917 THAs). A statistically significant risk stratification was observed about dislocation rate (5.98 ± 6.9% SF, 3.0 ± 1.9% non-SF Stiff and 2.26 ± 1.4% non-SF; p = 0.028). Similarly, about THA revision rate, a statistically significant risk stratification was also observed (7.3 ± 6.8% SF, 6.4 ± 3.1% non-SF Stiff and 2.7 ± 1.7% non-SF; p = 0.020). No statistically significant difference was observed when analysing AL, PJI and PF.
A statistically significant risk stratification of dislocation and revision rate was observed in the different PHSR, as theorised by the Bordeaux classification. Fused patients present a higher risk, degenerated and/or stiff spine an intermediate risk and mobile spines a lower risk profile. A standardised approach to THA candidate patients must consider the possible PSHR to improve clinical outcomes and reduce adverse events of THA.
目前的文献中越来越关注病理脊柱-髋关节关系（PSHR），旨在降低全髋关节置换术（THA）中假体撞击、脱位和边缘负荷的风险。本综述的主要目的是确定不同 PSHR 对初次 THA 结果和并发症谱的影响。次要目标是对不同 PSHR 患者亚组的风险进行分层。
根据 PRISMA 指南进行文献系统回顾。纳入比较有和无 PSHR（脊柱融合；确定僵硬脊柱和/或脊柱错位的退行性脊柱疾病）的患者初次 THA 结果和并发症发生率的随机对照试验、比较队列研究和病例对照研究。评估纳入研究的质量和偏倚风险。分析翻修率、并发症以及临床和影像学数据。并发症包括无菌性松动（AL）、假体周围关节感染（PJI）、髋关节脱位和假体周围骨折（PF）。
纳入 15 篇文章，共 3306342 例 THA。平均随访（FU）31.4±21.7 个月。人群分为三组：脊柱融合患者（48315 例 THA）；无融合但有脊柱僵硬的患者（106110 例 THA）；无融合且脊柱正常的患者（3151917 例 THA）。在脱位率方面观察到具有统计学意义的风险分层（5.98±6.9%SF，3.0±1.9%非 SF 僵硬，2.26±1.4%非 SF；p=0.028）。同样，在 THA 翻修率方面，也观察到具有统计学意义的风险分层（7.3±6.8%SF，6.4±3.1%非 SF 僵硬，2.7±1.7%非 SF；p=0.020）。在分析 AL、PJI 和 PF 时，未观察到统计学显著差异。
正如波尔多分类所假设的那样，不同 PHSR 的脱位和翻修率存在统计学显著的风险分层。融合患者风险较高，退行性和/或僵硬的脊柱风险中等，活动的脊柱风险较低。对 THA 候选患者必须采用标准化方法考虑可能的 PSHR，以改善临床结果并降低 THA 的不良事件。
