Houston Methodist, Institute for Technology, Innovation & Education, Houston, TX, USA.
Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Arch Orthop Trauma Surg. 2024 Nov;144(11):4707-4713. doi: 10.1007/s00402-024-05519-8. Epub 2024 Sep 9.
Recent projections suggest a substantial rise in demand for revision total hip arthroplasties, emphasizing the need for optimized perioperative care. Various revision techniques, such as isolated acetabular or femoral component revisions and total replacements, have garnered attention. Further research is needed to establish the most effective strategies for improving clinical outcomes.
This retrospective analysis utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File from 2016 to 2021. The study aimed to compare clinical characteristics and 30-day outcomes among patients undergoing combined acetabular and femoral (A + F) revision, acetabulum-only (A) revision, and femoral side-only (F) revision surgeries.
The analysis of 18,888 patients revealed crucial differences in preoperative and postoperative outcomes among various revision strategies. Specifically, there were notable variations in patient demographics, comorbidities, and emergency procedures. Postoperative data showed distinct rates of mortality, complications, and readmissions across the groups. Notably, femoral component revisions were associated with increased risks of mortality, transfusion, and urinary tract infections, underscoring the need for careful evaluation and consideration when opting for this revision approach.
The study's significance lies in its extensive patient cohort and multifaceted evaluation of revision strategies. Although consensus is lacking on single-component revisions, targeting the acetabulum component appears relatively safer. Continued research and individualized evaluations are crucial for refining revision strategies and optimizing outcomes in THA revisions.
最近的预测显示，翻修全髋关节置换术的需求将大幅增加，这强调了优化围手术期护理的必要性。各种翻修技术，如单独髋臼或股骨部件翻修和全置换，已经引起了关注。需要进一步的研究来确定改善临床结果的最有效策略。
本回顾性分析使用了 2016 年至 2021 年美国外科医师学会国家手术质量改进计划（ACS NSQIP）参与者使用文件中的数据。该研究旨在比较接受联合髋臼和股骨（A + F）翻修、单纯髋臼（A）翻修和股骨侧单纯翻修（F）手术的患者的临床特征和 30 天结局。
对 18888 例患者的分析揭示了各种翻修策略之间术前和术后结局的重要差异。具体而言，患者的人口统计学、合并症和急诊手术存在显著差异。术后数据显示，各组之间的死亡率、并发症和再入院率存在明显差异。值得注意的是，股骨部件翻修与死亡率、输血和尿路感染的风险增加相关，这突出表明在选择这种翻修方法时需要仔细评估和考虑。
本研究的意义在于其广泛的患者队列和对翻修策略的多方面评估。尽管对单部件翻修缺乏共识，但针对髋臼部件似乎相对更安全。持续的研究和个体化评估对于改进翻修策略和优化 THA 翻修的结果至关重要。
