Chao Long-Teng, Zhuang Teng-Feng, Huan Song-Wei, Luo Si-Min, Wu Chong-Jie, Wu Wen-Rui, Zha Zhen-Gang, Zhang Huan-Tian, Liu Ning
The First Clinical College, Jinan University & Department of Orthopedics, The First Affiliated Hospital, Jinan University, Guangzhou, China.
Orthop Surg. 2025 Mar;17(3):790-800. doi: 10.1111/os.14329. Epub 2024 Dec 23.
Charcot arthropathy is characterized by varying degrees of sensory loss and rapidly progressive joint destruction. Historically, limited studies indicated that Charcot arthropathy of the hip joint may be a contraindication for total hip arthroplasty (THA). Yet, some recent studies have shown that good clinical results and acceptable survival rate. Hence, this study aimed to investigate clinical outcomes, radiographic outcomes, complication rates and survivorship of primary THA in Charcot arthropathy.
We retrospectively included 11 patients (11 hips) with Charcot arthropathy who underwent THA between 1998 and 2016. All involved patients were diagnosed as syphilis. All patients had classic radiographic findings of Charcot arthropathy. The hip braces were used in all patients for six weeks after surgery. Outcome measures included VAS, Oxford Hip Score, and UCLA score. Statistical analyses involved t-tests, chi-square tests, and Kaplan-Meier survival analysis.
The average follow-up period was 81.73 months. The average VAS, Oxford Hip Score, and UCLA score were improved significantly. There was higher complication rate of 45.5% after THA. Reoperation was carried out in two patients due to dislocation and acetabular component loosening. The Kaplan-Meier survivorship with an end point of reoperation for any reason was 81.8%.
THA is proved to be reasonable in improving hip joint function, which is suitable for patients with Charcot hip joint. Although the complication rate is high, we consider that THA combined with hip brace may be a valid treatment choice for Charcot arthropathy with detailed preoperative planning and proper precautions.
夏科氏关节病的特征是不同程度的感觉丧失和迅速进展的关节破坏。从历史上看，有限的研究表明髋关节夏科氏关节病可能是全髋关节置换术（THA）的禁忌症。然而，最近的一些研究显示出良好的临床效果和可接受的生存率。因此，本研究旨在调查原发性THA治疗夏科氏关节病的临床结果、影像学结果、并发症发生率和生存率。
我们回顾性纳入了1998年至2016年间接受THA的11例（11髋）夏科氏关节病患者。所有纳入患者均被诊断为梅毒。所有患者均有夏科氏关节病的典型影像学表现。所有患者术后均使用髋部支具六周。结果指标包括视觉模拟评分（VAS）、牛津髋关节评分和加州大学洛杉矶分校（UCLA）评分。统计分析包括t检验、卡方检验和Kaplan-Meier生存分析。
平均随访期为81.73个月。平均VAS、牛津髋关节评分和UCLA评分均有显著改善。THA术后并发症发生率较高，为45.5%。两名患者因脱位和髋臼组件松动而进行了再次手术。以任何原因再次手术为终点的Kaplan-Meier生存率为81.8%。
THA被证明在改善髋关节功能方面是合理的，适用于夏科氏髋关节患者。虽然并发症发生率较高，但我们认为，结合术前详细规划和适当预防措施，THA联合髋部支具可能是治疗夏科氏关节病的有效选择。
