Darden Austin P, Deckard Evan R, Meneghini R Michael
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Indiana Joint Replacement Institute, Indianapolis, Indiana.
J Arthroplasty. 2025 Aug;40(8):2066-2072. doi: 10.1016/j.arth.2025.01.020. Epub 2025 Jan 19.
Use of jumbo femoral heads (≥ 40 mm) in total hip arthroplasty decreases postoperative dislocation; however, may leave patients more susceptible to groin pain. Limited data exist for the effect of jumbo femoral heads and acetabular cup position on modern patient-reported outcome measures (PROMs). This study evaluated the effect of jumbo femoral heads and acetabular cup position on PROMs after primary total hip arthroplasty.
A total of 328 consecutive primary THAs of a single implant system with various femoral head sizes (36% ≥ 40 mm) were retrospectively reviewed. Acetabular cup inclination and anteversion were radiographically measured. Demographics, comorbidities, and implant sizes were documented. Prospectively collected University of California Los Angeles Activity Level, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and satisfaction were evaluated. The mean follow-up was 1.2 years (range, one to five). A P-value of 0.05 was considered statistically significant.
Femoral head size was not associated with University of California Los AngelesActivity Level scores at any time point (P ≥ 0.209). Independent of patient sex, the mean HOOS JR score was significantly higher in the ≥ 40 mm femoral head group compared to the < 40 mm head group at 4 months although not reaching a clinically significant threshold (mean difference 4.4, 95% CI [confidence interval]: 0.5 to 8.3, P = 0.027); however, mean scores at the latest follow-up were not different (P = 0.956). The HOOS JR scores ≥ 90 and being "very satisfied or satisfied" were associated with a wide range and several combinations of acetabular cup inclination and anteversion. A total of 88.9% of patients reported being "very satisfied or satisfied" at the latest follow-up.
Patients achieved comparable PROMs regardless of femoral head size, suggesting large femoral heads may not leave patients susceptible to groin pain in addition to reducing the risk of postoperative dislocation. Excellent patient outcomes correlated with wide ranges of acetabular cup positions.
III.
在全髋关节置换术中使用超大股骨头（≥40毫米）可降低术后脱位的发生率；然而，这可能会使患者更容易出现腹股沟疼痛。关于超大股骨头和髋臼杯位置对现代患者报告结局指标（PROMs）影响的数据有限。本研究评估了超大股骨头和髋臼杯位置对初次全髋关节置换术后PROMs的影响。
回顾性分析了连续328例采用单一植入系统、不同股骨头尺寸（36%≥40毫米）的初次全髋关节置换术病例。通过X线测量髋臼杯的倾斜度和前倾角。记录患者的人口统计学资料、合并症和植入物尺寸。对前瞻性收集的加利福尼亚大学洛杉矶分校活动水平、髋关节残疾和骨关节炎关节置换结局评分（HOOS JR）以及满意度进行评估。平均随访时间为1.2年（范围1至5年）。P值<0.05被认为具有统计学意义。
在任何时间点，股骨头尺寸与加利福尼亚大学洛杉矶分校活动水平评分均无关联（P≥0.209）。在不考虑患者性别的情况下，尽管未达到临床显著阈值，但在术后4个月时，≥40毫米股骨头组的平均HOOS JR评分显著高于<40毫米股骨头组（平均差值4.4，95%置信区间[CI]：0.5至8.3，P = 0.027）；然而，在最近一次随访时，两组的平均评分无差异（P = 0.956）。HOOS JR评分≥90以及“非常满意或满意”与髋臼杯倾斜度和前倾角的广泛范围及多种组合相关。在最近一次随访中，共有88.9%的患者报告“非常满意或满意”。
无论股骨头尺寸如何，患者的PROMs相当，这表明大尺寸股骨头除了降低术后脱位风险外，可能不会使患者更容易出现腹股沟疼痛。良好的患者结局与髋臼杯位置的广泛范围相关。
III级
