Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
BMC Musculoskelet Disord. 2024 Jun 4;25(1):436. doi: 10.1186/s12891-024-07517-8.
Patients with osteonecrosis of the femoral head secondary to DDH frequently require total hip arthroplasty (THA), but it is not well understood which factors necessitate this requirement. We determined the incidence of THA in patients who have osteonecrosis secondary to DDH and factors associated with need for THA.
We included patients who received closed or open reductions between 1995 and 2005 with subsequent development of osteonecrosis. We determined osteonecrosis according to Bucholz and Ogden; osteoarthritis severity (Kellgren-Lawrence), subluxation (Shenton's line); neck-shaft angle; and acetabular dysplasia (centre-edge and Sharp angles). We also recorded the number of operations of the hip in childhood and reviewed case notes of patients who received THA to describe clinical findings prior to THA. We assessed the association between radiographic variables and the need for THA using univariate logistic regression.
Of 140 patients (169 hips), 22 patients received 24 THA (14%) at a mean age of 21.3 ± 3.7 years. Associated with the need for THA were grade III osteonecrosis (OR 4.25; 95% CI 1.70-10.77; p = 0.0019), grade IV osteoarthritis (21.8; 7.55-68.11; p < 0.0001) and subluxation (8.22; 2.91-29.53; p = 0.0003). All patients who required THA reported at least 2 of: severe pain including at night, stiffness, and reduced mobility. Acetabular dysplasia and number of previous operations were not associated with the need for THA.
We identified a 14% incidence of THA by age 34 years in patients with osteonecrosis secondary to DDH. Grade III osteonecrosis (global involvement femoral head and neck) was strongly associated with THA, emphasising the importance to avoid osteonecrosis when treating DDH.
继发于发育性髋关节发育不良（DDH）的股骨头坏死患者常需要全髋关节置换术（THA），但尚不清楚哪些因素需要进行这种治疗。本研究旨在确定继发于 DDH 的股骨头坏死患者中 THA 的发生率以及与 THA 需求相关的因素。
我们纳入了 1995 年至 2005 年间接受闭合或切开复位且随后发生股骨头坏死的患者。我们根据 Bucholz 和 Ogden 标准确定股骨头坏死；骨关节炎严重程度（Kellgren-Lawrence）；半脱位（Shenton 线）；颈干角；髋臼发育不良（中心边缘和 Sharp 角）。我们还记录了儿童期髋关节手术的次数，并回顾了接受 THA 的患者的病例记录，以描述 THA 前的临床发现。我们使用单变量逻辑回归评估影像学变量与 THA 需求之间的关系。
在 140 例患者（169 髋）中，22 例（14%）患者在平均 21.3±3.7 岁时接受了 24 次 THA。与 THA 需求相关的因素包括 III 级股骨头坏死（OR 4.25；95%CI 1.70-10.77；p=0.0019）、IV 级骨关节炎（21.8；7.55-68.11；p<0.0001）和半脱位（8.22；2.91-29.53；p=0.0003）。所有需要 THA 的患者均报告至少有 2 种以下情况：严重疼痛（包括夜间）、僵硬和活动受限。髋臼发育不良和既往手术次数与 THA 需求无关。
我们发现继发于 DDH 的股骨头坏死患者在 34 岁时 THA 的发生率为 14%。III 级股骨头坏死（股骨头和颈部广泛受累）与 THA 密切相关，这强调了在治疗 DDH 时避免股骨头坏死的重要性。
