Sang Weilin, Lai Peng, Xu Xun, Liu Yu, Ma Jinzhong, Zhu Libo
Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
Arthroplasty. 2024 May 3;6(1):25. doi: 10.1186/s42836-024-00249-z.
Controversy remains over whether different surgical approaches exert an impact on the component positioning in total hip arthroplasty. We conducted a retrospective study to reveal the long-term position of prostheses in the first group of patients in China who underwent direct anterior hip arthroplasty.
Collected were data from 350 patients who underwent direct anterior hip arthroplasty between 2008 and 2013, including demographic information, imaging data, Harris hip scores, and surgical complications. Variables, measured radiographically or by CT, included hip offset, leg length discrepancy, component position, and stability within one week after surgery and at the last follow-up. The data were subjected to statistical analysis by using paired t-tests and Pearson chi-square tests.
Data were harvested by follow-up and self-reported questionnaires. The postoperative follow-up lasted for 13.1 years on average (minimum, 10 years; maximum, 15 years), and the overall survival rate of hip prostheses was 96.3%. The mean Harris score at the final follow-up was 91.8 points. After excluding patients with significant preoperative hip deformities, the incidence of postoperative limb inequality (> 5 mm) was 4.9% at the last follow-up, and the incidence of hip offset discrepancy (> 5 mm) was 14.6%. The overall proportion of the acetabular components located in the Lewinnek safe zone was 77.7%, whereas the proportion of femoral prostheses in the safe zone (< 3° inclination) was 94.0%. Based on the revised data and the last follow-up imaging, the total proportion of acetabular and femoral prostheses with a radiolucence of > 2 mm was 5.1%.
Direct anterior approach hip arthroplasty could achieve excellent component positioning and long-term prosthesis survival in patients without severe hip deformities.
在全髋关节置换术中，不同的手术入路是否会对假体组件的位置产生影响仍存在争议。我们进行了一项回顾性研究，以揭示中国第一组接受直接前方髋关节置换术患者假体的长期位置。
收集了2008年至2013年间接受直接前方髋关节置换术的350例患者的数据，包括人口统计学信息、影像学数据、Harris髋关节评分和手术并发症。通过X线或CT测量的变量包括髋关节偏移、肢体长度差异、组件位置以及术后1周和最后一次随访时的稳定性。数据采用配对t检验和Pearson卡方检验进行统计分析。
通过随访和自我报告问卷收集数据。术后随访平均持续13.1年（最短10年；最长15年），髋关节假体的总体生存率为96.3%。最后一次随访时的平均Harris评分为91.8分。排除术前有明显髋关节畸形的患者后，最后一次随访时术后肢体不等长（>5mm）的发生率为4.9%，髋关节偏移差异（>5mm）的发生率为14.6%。髋臼组件位于Lewinnek安全区的总体比例为77.7%，而股骨假体在安全区（倾斜度<3°）的比例为94.0%。根据修正后的数据和最后一次随访影像学检查，假体周围透亮区>2mm的髋臼和股骨假体的总比例为5.1%。
对于没有严重髋关节畸形的患者，直接前方入路髋关节置换术可以实现良好的组件定位和假体的长期存活。
