Konishi Toshiki, Hamai Satoshi, Kawahara Shinya, Hara Daisuke, Sato Taishi, Yamate Satoshi, Motomura Goro, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Artificial Joints and Biomaterials, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Sci Rep. 2025 Mar 19;15(1):9530. doi: 10.1038/s41598-025-93547-8.
Leg length discrepancy (LLD), offset, and anatomical abnormalities such as a high-riding greater trochanter are key factors that may influence the outcomes of total hip arthroplasty (THA). Understanding how these factors affect patient-reported outcomes (PROs) is crucial for optimizing surgical techniques and improving patient satisfaction. This study investigated whether preoperative and postoperative LLD, offset, and a preoperative high-riding greater trochanter influence PROs in unilateral THA. A questionnaire survey was conducted targeting 1,010 individuals who underwent primary THA. Of the 652 respondents (62%), 203 with healthy contralateral sides were included. PROs were assessed using the Forgotten Joint Score-12 (FJS-12), Oxford Hip Score (OHS), and Visual Analogue Scale (VAS)-Satisfaction. Anteroposterior radiographs taken before and one week after surgery were used to measure LLD, femoral offset, acetabular offset, global offset, and articular trochanteric distance (ATD). A high-riding greater trochanter was defined as an ATD < 0 mm. Multivariable analyses revealed that a longer leg on the surgical side postoperatively (P = 0.0004) and a preoperative high-riding greater trochanter (P = 0.01) were negative factors for FJS-12. Older age (P = 0.0004) and higher body mass index (P = 0.04) were negative factors for OHS. Male sex negatively affected VAS-Satisfaction (P = 0.04). This study is the first to reveal that a longer postoperative leg on the surgical side and the presence of a high-riding greater trochanter leads to a decrease in the FJS-12 score independently. Therefore, to improve joint stability, it may be more beneficial to increase offset rather than extend leg length.
肢体长度差异（LLD）、偏移以及诸如高位大转子等解剖学异常是可能影响全髋关节置换术（THA）结果的关键因素。了解这些因素如何影响患者报告的结局（PROs）对于优化手术技术和提高患者满意度至关重要。本研究调查了单侧THA术前和术后的LLD、偏移以及术前高位大转子是否会影响PROs。针对1010例行初次THA的个体进行了问卷调查。在652名受访者（62%）中，纳入了203名对侧健康的个体。使用遗忘关节评分12（FJS-12）、牛津髋关节评分（OHS）和视觉模拟量表（VAS）-满意度来评估PROs。手术前后拍摄的前后位X线片用于测量LLD、股骨偏移、髋臼偏移、整体偏移和关节转子间距离（ATD）。高位大转子定义为ATD < 0 mm。多变量分析显示，术后手术侧肢体较长（P = 0.0004）和术前高位大转子（P = 0.01）是FJS-12的负面因素。年龄较大（P = 0.0004）和体重指数较高（P = 0.04）是OHS的负面因素。男性对VAS-满意度有负面影响（P = 0.04）。本研究首次揭示，术后手术侧肢体较长以及存在高位大转子会独立导致FJS-12评分降低。因此，为了提高关节稳定性，增加偏移可能比延长肢体长度更有益。
