Department of Orthopaedics, University of Utah, Salt Lake City, Utah.
J Arthroplasty. 2024 Sep;39(9S1):S131-S137. doi: 10.1016/j.arth.2024.04.060. Epub 2024 Apr 25.
Total hip arthroplasty (THA) is often performed in symptomatic patients who have hip dysplasia and do not qualify for periacetabular osteotomy. The impact of osteoarthritis (OA) severity on postoperative outcomes in dysplasia patients who undergo THA is not well described. We hypothesized that dysplasia patients who have mild OA have slower initial recovery postoperatively but similar one-year patient-reported outcome measures (PROMs) compared to dysplasia patients who have severe OA.
We performed a retrospective review at a single academic institution over a 6-year period of patients who have dysplasia who underwent THA compared to patients who have primary OA who underwent THA. There were 263 patients who had dysplasia, compared to 1,225 THA patients who did not have dysplasia. Within the dysplasia cohort, we compared PROMs stratified by dysplasia and OA severity. The diagnosis of dysplasia was verified using the radiographic lateral center edge angle. A minimum one-year follow-up was required. The PROMs were collected through one year postoperatively. Logistic and linear regression models were used, adjusting for age, sex, body mass index, and Charlson comorbidity index.
No significant differences were found in postoperative PROMs or revision rates (P = .58). When stratified by dysplasia severity, patients who had lower lateral center edge angle had more improvement in physical function scores from preoperative to 2 weeks (P < .01) and higher physical function scores at 2 weeks (P = .03). When stratified by OA severity, patients who had a worse Tönnis score had more improvement in physical function scores from preoperative to 2 weeks (P < .01). Recovery curves in dysplasia patients based on dysplasia and OA severity were not significantly different at 6 weeks, 1 year, and 2 years postoperative.
Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. We believe that THA is a reasonable surgical intervention for symptomatic dysplasia patients who have mild arthritis and do not qualify for periacetabular osteotomy.
全髋关节置换术（THA）常用于髋发育不良且不符合髋臼周围截骨术适应证的有症状患者。髋发育不良患者中骨关节炎（OA）严重程度对 THA 术后结果的影响尚未得到很好的描述。我们假设，OA 轻度的髋发育不良患者术后初始恢复较慢，但与 OA 严重或无髋发育不良的患者相比，其一年的患者报告结局测量（PROM）相似。
我们在一家学术机构进行了一项回顾性研究，比较了 6 年内接受 THA 的髋发育不良患者与接受 THA 的原发性 OA 患者。髋发育不良患者有 263 例，而无髋发育不良的 THA 患者有 1225 例。在发育不良队列中，我们比较了按发育不良和 OA 严重程度分层的 PROM。通过放射学外侧中心边缘角来验证发育不良的诊断。需要至少一年的随访。术后 PROM 通过一年收集。使用逻辑和线性回归模型，调整年龄、性别、体重指数和 Charlson 合并症指数。
在术后 PROM 或翻修率方面无显著差异（P=0.58）。按发育不良严重程度分层时，较低的外侧中心边缘角患者从术前到 2 周时的身体功能评分改善更大（P＜0.01），2 周时的身体功能评分更高（P=0.03）。按 OA 严重程度分层时，Tönnis 评分较差的患者从术前到 2 周时的身体功能评分改善更大（P＜0.01）。根据发育不良和 OA 严重程度，髋发育不良患者的恢复曲线在术后 6 周、1 年和 2 年时无显著差异。
髋发育不良伴轻度 OA 的患者与重度 OA 或无髋发育不良的患者相比，恢复曲线相似。我们认为，对于有症状且轻度关节炎且不符合髋臼周围截骨术适应证的髋发育不良患者，THA 是一种合理的手术干预措施。
