Ocokoljic Ana, Krivec Lukas, Alimy Assil-Ramin, Simon Alexander, Strahl André, Beil Frank Timo, Rolvien Tim
Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):7. doi: 10.1007/s00402-024-05615-9.
Patients with primary hip osteoarthritis undergoing unilateral total hip arthroplasty (THA) often face uncertainty about the future need for arthroplasty in the contralateral hip. We aimed to identify parameters that have predictive value with regard to the necessity for contralateral THA or the development of contralateral radiographic osteoarthritis (OA) phenotypes following index surgery.
In this retrospective study, we analyzed 220 patients undergoing THA. Of these, 24.1% required contralateral THA at a mean follow-up of 18.3months. Our assessments included preoperative and follow-up pelvis radiographs as well as bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry prior to index THA. Comprehensive radiological measurements such as the Kellgren-Lawrence OA grade, osteophyte evaluation as well as joint shape and alignment (including alpha and CE angles) were performed.
We identified three indicators at the initial assessment for predicting the need for contralateral THA: higher BMI (odds ratio (OR) 1.1 [95%-CI 1.0-1.2], p = 0.033), higher alpha angles (> 61.5°) (OR 2.5 [95%-CI 1.0-6.3], p = 0.045) and the presence of multiple osteophytes (OR 2.6 [95%-CI 1.4-4.9], p = 0.004). Moreover, higher alpha angles were linked to more severe radiographic OA, especially osteophytosis. Higher BMD T-scores were also associated with progressive formation of multiple and large osteophytes but not joint space narrowing.
Three factors - BMI, alpha angle, and osteophyte number - are key short-term predictors for contralateral THA after index THA. We also identified BMD as a surrogate for osteophyte formation. These findings provide novel and valuable insights for patients and surgeons regarding risks and counseling for contralateral OA and THA.
接受单侧全髋关节置换术（THA）的原发性髋关节骨关节炎患者常常对未来对侧髋关节是否需要进行关节置换术感到不确定。我们旨在确定对侧THA必要性或初次手术后对侧影像学骨关节炎（OA）表型发展具有预测价值的参数。
在这项回顾性研究中，我们分析了220例行THA的患者。其中，24.1%在平均18.3个月的随访中需要对侧THA。我们的评估包括术前和随访时的骨盆X线片，以及初次THA前通过双能X线吸收法测量骨密度（BMD）。进行了诸如Kellgren-Lawrence OA分级、骨赘评估以及关节形状和对线（包括α角和CE角）等全面的影像学测量。
我们在初次评估时确定了三个预测对侧THA需求的指标：较高的体重指数（BMI）（比值比（OR）1.1 [95%可信区间1.0 - 1.2]，p = 0.033）、较高的α角（> 61.5°）（OR 2.5 [95%可信区间1.0 - 6.3]，p = 0.045）以及存在多个骨赘（OR 2.6 [95%可信区间1.4 - 4.9]，p = 0.004）。此外，较高的α角与更严重的影像学OA相关，尤其是骨赘形成。较高的BMD T值也与多个大骨赘的逐渐形成相关，但与关节间隙变窄无关。
三个因素——BMI、α角和骨赘数量——是初次THA后对侧THA的关键短期预测指标。我们还确定BMD可作为骨赘形成的替代指标。这些发现为患者和外科医生提供了关于对侧OA和THA风险及咨询的新颖且有价值的见解。
