Ansari S, Gupta T, Pranav J, Gupta K, Raja B S, Biswas A, Kalia R B
Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Musculoskelet Surg. 2025 Feb 20. doi: 10.1007/s12306-025-00895-9.
A systematic review of the literature was performed in order to synthesize the available data on the outcome of conversion total hip arthroplasty after failed hemiarthroplasty keeping in mind the higher complication rates of conversion as compared to a primary total hip arthroplasty.
Comprehensive search of literature was performed for the systematic review through online databases-PubMed, EMBASE, Scopus, and the Cochrane database. The abstracts were identified first by the above-mentioned search methods and were assessed for eligibility based on strict criteria. 15 studies regarding conversion hemiarthroplasty were finally included for the study.
The 15 studies evaluating 3432 hips revealed that the main indication for conversion to arthroplasty was pain in the groin or thigh symptomatically and acetabular erosion with well-fixed femoral stem (455 cases; 13.25%) radiologically. Majority of the cases were revised in a single stage (292 cases) as compared to 25 cases revised in 2-stage surgery mostly owing to infection. The mean pre-conversion Harris Hip Score (HHS) improved from 45.74 to 84.03 in the post-conversion time. Majority of the conversions constituted cemented fixation for the femoral component and uncemented fixation for the acetabular component. Mean survivorship was found to be 97.21% at 5-6 years. The conversions were most commonly complicated by prosthetic joint infection most commonly which was managed by long-term antibiotics and/or debridement with or without exchange of implants.
The conversion group had consistently higher odds of prosthetic joint dislocation, prosthetic joint infection, periprosthetic fracture, aseptic loosening and revision both at 1- and 2-year follow-ups. It was also noteworthy that the odds of developing these complications increased significantly from 1-year follow-up to the 2 years follow-up.
对文献进行系统综述，以综合分析半髋关节置换失败后行全髋关节置换术的结果，同时考虑到与初次全髋关节置换术相比，翻修手术的并发症发生率更高。
通过在线数据库——PubMed、EMBASE、Scopus和Cochrane数据库，对文献进行全面检索以进行系统综述。首先通过上述检索方法识别摘要，并根据严格标准评估其是否符合纳入条件。最终纳入15项关于半髋关节置换翻修术的研究进行分析。
这15项评估3432例髋关节的研究表明，转为关节置换术的主要指征是腹股沟或大腿出现疼痛症状，以及影像学显示髋臼侵蚀且股骨柄固定良好（455例；13.25%）。大多数病例采用一期翻修（292例），而二期翻修手术仅25例，主要原因是感染。翻修术后，Harris髋关节评分（HHS）平均从术前的45.74提高到术后的84.03。大多数翻修手术中，股骨部件采用骨水泥固定，髋臼部件采用非骨水泥固定。5至6年时的平均生存率为97.21%。翻修手术最常见的并发症是人工关节感染，通常采用长期抗生素治疗和/或清创术，必要时更换植入物。
在1年和2年的随访中，翻修组发生人工关节脱位、人工关节感染、假体周围骨折、无菌性松动和再次翻修的几率始终较高。同样值得注意的是，从1年随访到2年随访，发生这些并发症的几率显著增加。
