Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Hip Int. 2024 Jul;34(4):503-509. doi: 10.1177/11207000241234030. Epub 2024 Apr 15.
Ehlers-Danlos syndromes (EDS) are genetic connective tissue disorders affecting multiple organ systems that frequently result in connective tissue hyperlaxity and early osteoarthritis. Short- and long-term outcomes after primary total hip arthroplasty (THA) in this patient population remain poorly characterised. The primary purpose of this study is to compare postoperative outcomes and survivorship after primary THA in patients with and without EDS.
The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for all patients undergoing primary elective THA between September 2009 and December 2020. Patients with EDS were identified using ICD9 and ICD10 diagnosis codes. Given the relatively low incidence of EDS in this patient population, the cohort was propensity-matched 1:10 to patients without diagnosis of EDS based on demographics characteristics and medical comorbidities as measured by the Elixhauser Comorbidity Index.
A total of 66 THA patients with and 660 without EDS were included in each group after 1:10 propensity-matching. There were no significant differences in baseline characteristics or THA indications. Early postoperative outcomes such as length of hospital stay and discharge disposition were similar. Emergency Room visits and inpatient readmission rates at 3 months postoperatively did not significantly differ between groups. Patients with EDS had a higher overall revision rate compared to those without (15.0% vs. 3.2%, 0.001). Revision free survival after primary THA in patients with EDS was significantly lower than those without EDS at 9-year follow-up. Cox proportional hazard regression demonstrated EDS patients had 7-times higher risk of revision (hazard ratio [HR] 7.43; 95% CI, 3.46-16.00; 0.001). Lastly, revision due to instability insignificantly trended higher in the EDS cohort (HR 2.29; 95% CI, 0.95-5.49; 0.063).
EDS patients undergoing primary THA have increased rate of all cause revision and demonstrate decreased revision free survival compared to non-EDS THA patients.
埃勒斯-当洛斯综合征（EDS）是一种影响多个器官系统的遗传性结缔组织疾病，常导致结缔组织过度松弛和早期骨关节炎。在这一患者群体中，初次全髋关节置换术（THA）后的短期和长期结果仍描述不佳。本研究的主要目的是比较 EDS 患者和无 EDS 患者初次 THA 后的术后结果和生存率。
纽约州全州规划和研究合作系统（SPARCS）数据库被查询了 2009 年 9 月至 2020 年 12 月期间所有接受初次选择性 THA 的患者。使用 ICD9 和 ICD10 诊断代码识别 EDS 患者。鉴于该患者群体中 EDS 的发病率相对较低，根据人口统计学特征和 Elixhauser 合并症指数衡量的医疗合并症，对该队列进行了 1:10 的倾向匹配，以匹配无 EDS 诊断的患者。
在 1:10 倾向匹配后，每组各有 66 例 THA 患者和 660 例无 EDS 患者纳入研究。基线特征和 THA 适应证无显著差异。术后早期结果，如住院时间和出院去向，相似。两组术后 3 个月急诊就诊率和住院再入院率无显著差异。与无 EDS 患者相比，EDS 患者的总翻修率更高（15.0% vs. 3.2%，P < 0.001）。在 9 年随访时，EDS 患者初次 THA 后的翻修无生存率明显低于无 EDS 患者。Cox 比例风险回归显示，EDS 患者的翻修风险高 7 倍（危险比 [HR] 7.43；95%CI，3.46-16.00；P < 0.001）。最后，EDS 组因不稳定而翻修的比例略有增加（HR 2.29；95%CI，0.95-5.49；P = 0.063）。
接受初次 THA 的 EDS 患者翻修率较高，与非 EDS THA 患者相比，翻修无生存率降低。
