From the Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD.
J Am Acad Orthop Surg Glob Res Rev. 2024 Feb 5;8(2). doi: 10.5435/JAAOSGlobal-D-23-00132. eCollection 2024 Feb 1.
There is a paucity of literature that examines how the abnormal spinopelvic alignment of scoliosis affects outcomes after total hip arthroplasty (THA) in the absence of a lumbar fusion.
Patients with a history of scoliosis (idiopathic, adolescent, degenerative, or juvenile) without fusion and those without a history of scoliosis who underwent primary THA were identified using a large national database. Ninety-day incidence of various medical complications, emergency department (ED) visit, and readmission and 1-year incidence of surgery-related complications and cost of care were evaluated in both the scoliosis and control cohorts. Propensity score matching was used to control for patient demographic factors and comorbidities as covariates.
After propensity matching, 21,992 and 219,920 patients were identified in the scoliosis and control cohorts, respectively. Patients with scoliosis were at increased risk of several 90-day medical complications, including pulmonary embolism (odds ratio [OR] 1.96; P < 0.001), deep vein thrombosis (1.49; P < 0.001), transfusion (OR, 1.13; P < 0.001), pneumonia (OR, 1.37; P < 0.001), myocardial infarction (OR, 1.38; P = 0.008), sepsis (OR, 1.59; P < 0.001), acute anemia (OR, 1.21; P < 0.001), and urinary tract infection (OR, 1.1; P = 0.001). Patients with a history of scoliosis were at increased 1-year risk of revision (OR, 1.31; P < 0.001), periprosthetic joint infection (OR, 1.16; P = 0.0089), dislocation (OR, 1.581; P < 0.001), and aseptic loosening (OR, 1.39; P < 0.001) after THA. Patients with scoliosis without a history of fusion were more likely to return to the emergency department (OR, 1.26; P < 0.001) and be readmitted (OR, 1.78; P < 0.001) within 90 days of THA.
Patients with even a remote history of scoliosis without fusion are at increased risk of 90-day medical and surgery-related complications after hip arthroplasty. Hip and spine surgeons should collaborate in future studies to best understand how to optimize these patients for their adult reconstructive procedures.
目前关于脊柱侧凸患者在未行腰椎融合术的情况下，其脊柱-骨盆矢状面参数异常对全髋关节置换术（THA）后结果的影响的文献较少。
本研究使用大型国家数据库，确定了有脊柱侧凸（特发性、青少年型、退行性或青少年型）病史但未行融合术的患者，以及无脊柱侧凸病史但行初次 THA 的患者。在脊柱侧凸组和对照组中，评估了 90 天内各种医疗并发症、急诊就诊和再入院的发生率，以及 1 年时手术相关并发症和治疗费用。采用倾向评分匹配法控制患者的人口统计学因素和合并症作为协变量。
在进行倾向评分匹配后，在脊柱侧凸组和对照组中分别确定了 21992 例和 219920 例患者。脊柱侧凸患者发生多种 90 天内医疗并发症的风险增加，包括肺栓塞（比值比[OR]1.96；P<0.001）、深静脉血栓形成（1.49；P<0.001）、输血（OR，1.13；P<0.001）、肺炎（OR，1.37；P<0.001）、心肌梗死（OR，1.38；P=0.008）、脓毒症（OR，1.59；P<0.001）、急性贫血（OR，1.21；P<0.001）和尿路感染（OR，1.1；P=0.001）。有脊柱侧凸病史的患者在 1 年内发生翻修术（OR，1.31；P<0.001）、假体周围关节感染（OR，1.16；P=0.0089）、脱位（OR，1.581；P<0.001）和无菌性松动（OR，1.39；P<0.001）的风险增加。无融合术史的脊柱侧凸患者在 THA 后 90 天内更有可能返回急诊（OR，1.26；P<0.001）和再次入院（OR，1.78；P<0.001）。
即使是无融合术史的脊柱侧凸患者，在髋关节置换术后 90 天内也有发生医疗和手术相关并发症的风险增加。髋关节和脊柱外科医生应在未来的研究中合作，以更好地了解如何为这些患者的成人重建手术进行优化。
