Schneider Andrew, Molina MacKenzie, Pitz-Gonçalves Lauren I, Estes Braeden W, Deckard Evan R, Sonn Kevin A, 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(8S1):S143-S151. doi: 10.1016/j.arth.2025.03.063. Epub 2025 Mar 28.
Enabling technology, such as computer navigation and robotics, provides more precise implant position, which allows surgeons the ability for personalized alignment in total hip arthroplasty (THA). To date, THA implant position studies have focused on dislocation rates, rather than on patient-reported outcome measures (PROMs). This study evaluated the impact of the THA component position on clinically significant differences in PROMs.
A total of 1,682 consecutive primary THAs were retrospectively reviewed. Acetabular and femoral component position as well as femoral offset and leg-length discrepancy (LLD) were measured on all preoperative and postoperative radiographs. Modern PROM scores were evaluated. Minimal clinically important difference (MCID), substantial clinical benefit, and patient-acceptable symptom state values were assessed for applicable PROMs. Univariate and multivariate statistical analyses were performed with P < 0.05 as significant. The mean clinical follow-up was 21.9 months (range, one to 128).
In multivariate analysis, the acetabular component position closer to the native hip center of rotation was associated with a greater probability of achieving the Hip disability and Osteoarthritis Outcome Score for Joint Replacement MCID, substantial clinical benefit, and patient-acceptable symptom state thresholds (P ≤ 0.008). An increase in postoperative femoral offset was associated with achieving the MCID for the University of California Los Angeles activity level and patients being 'very satisfied or satisfied' (P ≤ 0.004). The mean postoperative LLD was 3.8 mm (range, 24.5 mm short to 36.6 mm long); however, postoperative LLD was not a predictor of PROMs (P ≥ 0.167) with statistical power ≥ 87%.
Study results demonstrated that replicating the native center of rotation and optimizing femoral offset was associated with clinically relevant improvements in PROMs. Interestingly, in this large cohort, leg length inequality was not associated with PROMs. Further research is warranted on THA component position, including spino-pelvic parameters and PROMs.
III.
诸如计算机导航和机器人技术等使能技术能提供更精确的植入物位置，这使得外科医生在全髋关节置换术（THA）中能够进行个性化对线。迄今为止，THA植入物位置研究主要集中在脱位率上，而非患者报告的结局指标（PROMs）。本研究评估了THA组件位置对PROMs中具有临床意义差异的影响。
回顾性分析了连续1682例初次THA病例。在所有术前和术后X线片上测量髋臼和股骨组件位置以及股骨偏心距和肢体长度差异（LLD）。评估现代PROM评分。对适用的PROMs评估最小临床重要差异（MCID）、显著临床获益和患者可接受症状状态值。进行单因素和多因素统计分析，P<0.05为有统计学意义。平均临床随访时间为21.9个月（范围1至128个月）。
在多因素分析中，髋臼组件位置越接近天然髋关节旋转中心，达到髋关节残疾和骨关节炎关节置换结局评分的MCID、显著临床获益以及患者可接受症状状态阈值的可能性越大（P≤0.008）。术后股骨偏心距增加与达到加利福尼亚大学洛杉矶分校活动水平的MCID以及患者“非常满意或满意”相关（P≤0.004）。术后平均LLD为3.8mm（范围，短24.5mm至长36.6mm）；然而，术后LLD不是PROMs的预测因素（P≥0.167），统计效能≥87%。
研究结果表明，复制天然旋转中心并优化股骨偏心距与PROMs的临床相关改善有关。有趣的是，在这个大型队列中，肢体长度不等与PROMs无关。有必要对THA组件位置进行进一步研究，包括脊柱骨盆参数和PROMs。
III级。
