Hecht Christian J, Lavu Monish S, Kaelber David C, Homma Yasuhiro, Kamath Atul F
Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
J Orthop. 2024 Apr 1;53:140-146. doi: 10.1016/j.jor.2024.03.036. eCollection 2024 Jul.
Although gluteal tears have been observed in a substantial percentage of total hip arthroplasty (THA) patients and hip osteoarthritis (OA) has been shown to alter the function of the gluteal muscles, the association between gluteal tears and hip OA has not been characterized. Therefore, we evaluated (1) the overlap between hip OA and gluteal tears, (2) the relative risks of gluteal tears in patients who have hip OA, and (3) gluteal tear-free survival after diagnosis or treatment for hip osteoarthritis.
This retrospective study sourced data from TriNetX, a research network that aggregates data from over 92 million patients. Relative risks for gluteal tears were calculated for known risk factors for gluteal tears, age ≥45 years, female sex, and obesity, as well as for hip OA, hip injections, and THA. A subgroup analysis was performed utilizing a Cox proportional hazard model for patients who were diagnosed with hip OA, received a hip injection, or underwent THA in 2015 to assess gluteal tear-free survival over a 9-year timeframe.
There was a large degree of overlap between patients with hip OA and gluteal tears, as 17.9% of patients with hip OA and 27.5% of patients with a gluteal tear also had the other pathology. Hip OA was associated with a markedly increased risk of a gluteal tear compared to healthy controls (Relative risk: 26.75, 95% CI: 26.64-26.86). Upon controlling for the established risk factors of gluteal tears, patients with hip OA had a markedly more likely to subsequently be diagnosed with an abductor tear (Hazard ratio: 12.46, 95% CI: 11.75-13.22).
Overall, these findings suggest a strong association between hip OA and the development of gluteal tears, in which further investigation is merited to determine the biomechanical pathophysiology underlying this potential relationship to inform prevention and treatment strategies.
尽管在相当比例的全髋关节置换术（THA）患者中观察到臀肌撕裂，并且已证明髋骨关节炎（OA）会改变臀肌的功能，但臀肌撕裂与髋OA之间的关联尚未得到明确描述。因此，我们评估了（1）髋OA与臀肌撕裂之间的重叠情况，（2）髋OA患者发生臀肌撕裂的相对风险，以及（3）髋骨关节炎诊断或治疗后的无臀肌撕裂生存期。
这项回顾性研究的数据来自TriNetX，这是一个汇总了超过9200万患者数据的研究网络。计算了臀肌撕裂已知风险因素（年龄≥45岁、女性和肥胖）以及髋OA、髋关节注射和THA患者发生臀肌撕裂的相对风险。利用Cox比例风险模型对2015年被诊断为髋OA、接受髋关节注射或接受THA的患者进行亚组分析，以评估9年时间内的无臀肌撕裂生存期。
髋OA患者和臀肌撕裂患者之间存在很大程度的重叠，因为17.9%的髋OA患者和27.5%的臀肌撕裂患者也患有另一种病理情况。与健康对照组相比，髋OA与臀肌撕裂风险显著增加相关（相对风险：26.75，95%置信区间：26.64 - 26.86）。在控制臀肌撕裂的既定风险因素后，髋OA患者随后被诊断为外展肌撕裂的可能性明显更高（风险比：12.46，95%置信区间：11.75 - 13.22）。
总体而言，这些发现表明髋OA与臀肌撕裂的发生之间存在密切关联，值得进一步研究以确定这种潜在关系背后的生物力学病理生理学，为预防和治疗策略提供依据。
