Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois.
J Arthroplasty. 2024 Dec;39(12):3070-3075. doi: 10.1016/j.arth.2024.06.036. Epub 2024 Jun 21.
Trochanteric bursitis (TB) is a prevalent complication following total hip arthroplasty (THA), with increased offset hypothesized as a potential risk factor. This study investigated potential TB predictors in THA patients, including radiographic measurements of offset and leg length, comorbidities, and patient characteristics.
In this retrospective cohort study, all THA patients from a single academic tertiary care center between 2005 and 2021 were reviewed. Exclusion criteria included less than one-year follow-up, osteonecrosis, or fracture. Manual radiographic measurements of offset (acetabular, femoral, and total) and leg length from preoperative and postoperative antero-posterior pelvis X-rays were taken, with scaling using femoral cortical diameter. Univariable and multivariable Cox proportional hazard models were employed to estimate TB risk.
Of 1,094 patients, 103 (9.4%) developed TB, with a median (Q1, Q3) time to presentation of 41.8 weeks (25.5, 66.9). In univariable models, only sex was associated with increased TB risk, with women exhibiting a 1.79 times increased risk (hazard ratio: 1.79 (1.16, 2.76), P = .009). Changes in acetabular offset, femoral offset, total offset, and leg length between preoperative and postoperative radiographs were not associated with an increased risk of developing TB in the univariate or multivariate models. Furthermore, various offset thresholds were evaluated, with no amount of increased offset showing increased TB risk.
This study found no relationship between femoral, acetabular, or total offset and TB following THA. These findings suggest that surgeons may consider adding offset for increased prosthetic stability in high-risk cases. However, given that this is a retrospective study, the authors are not advocating for the routine use of increased offset. The study identified women as a risk factor with a 1.79 times higher TB risk, highlighting the importance of counseling women patients on this heightened risk.
转子滑囊炎（TB）是全髋关节置换术（THA）后的一种常见并发症，增加的偏心距被认为是一个潜在的危险因素。本研究调查了 THA 患者中潜在的 TB 预测因素，包括偏心距和腿长的放射学测量、合并症和患者特征。
在这项回顾性队列研究中，对 2005 年至 2021 年期间在一家学术性三级护理中心接受 THA 的所有患者进行了回顾。排除标准包括随访时间少于一年、骨坏死或骨折。对术前和术后前后骨盆 X 线片进行了髋臼、股骨和总偏心距以及腿长的手动放射学测量，并使用股骨皮质直径进行了缩放。采用单变量和多变量 Cox 比例风险模型来估计 TB 风险。
在 1094 名患者中，有 103 名（9.4%）发生了 TB，中位（Q1，Q3）出现时间为 41.8 周（25.5，66.9）。在单变量模型中，只有性别与增加的 TB 风险相关，女性的风险增加了 1.79 倍（风险比：1.79（1.16，2.76），P=0.009）。术前和术后 X 线片上髋臼偏心距、股骨偏心距、总偏心距和腿长的变化在单变量或多变量模型中与 TB 风险增加无关。此外，评估了各种偏心距阈值，没有增加的偏心距量显示出增加的 TB 风险。
本研究发现 THA 后股骨、髋臼或总偏心距与 TB 之间没有关系。这些发现表明，外科医生可能会考虑在高风险病例中增加偏心距以增加假体稳定性。然而，由于这是一项回顾性研究，作者并不主张常规使用增加的偏心距。该研究确定女性是一个风险因素，TB 风险增加 1.79 倍，这突出表明需要对女性患者进行风险增加的咨询。
