Thewlis Dominic, Bahl Jasvir, Chai Hao Wei Harvey, Callary Stuart A, Grace Thomas M, Arnold John B, Taylor Mark, Solomn Lucian B
Centre for Orthopaedic and Trauma Research, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, Australia.
Arthroplast Today. 2025 Apr 12;33:101681. doi: 10.1016/j.artd.2025.101681. eCollection 2025 Jun.
Revision total hip arthroplasty (THA) has been reported to have worse outcomes when compared to primary procedures, which may, in part, be due to the increased exposure required for the procedure. We aimed to investigate the postoperative functional outcomes of 2 groups of primary and revision THA, when revision procedures were performed using a gluteal-sparing extended posterior approach.
Two groups of 51 primary and 21 revision THAs were prospectively recruited from a single center between 2016 and 2019. Both groups were assessed preoperatively using quantitative gait analysis and patient-reported outcomes, and at 3 and 12 months postoperatively. Hip and knee kinematics were computed from motion capture data acquired at the gait analysis. Kinematic and patient-reported outcome measures data were analyzed using linear mixed models. Statistical parametric analysis complemented the main analysis of the kinematics.
Patients in the primary group had worse preoperative patient-reported outcome measures when compared to the revision group. There were no between-group differences in walking speed. Hip extension in late stance phase of gait was 9° and 5° lower for the revision group when compared to the primary group at 3 and 12 months, respectively. These differences were not statistically significant, but the magnitude of the effect size was noteworthy suggesting a functional deficit (Cohen's = 0.64 and 0.54, respectively).
Revision THA using a gluteal-sparing extended posterior approach may be able to achieve similar patient-reported and gait outcomes with those of primary THA within the first 12 postoperative months.
据报道，与初次全髋关节置换术（THA）相比，翻修全髋关节置换术的预后较差，这可能部分归因于手术所需的暴露增加。我们旨在研究当采用保留臀肌的扩大后外侧入路进行翻修手术时，两组初次和翻修THA的术后功能结果。
2016年至2019年间，从单一中心前瞻性招募了两组患者，分别为51例初次THA和21例翻修THA。两组患者术前均采用定量步态分析和患者报告的结局进行评估，并在术后3个月和12个月进行评估。通过步态分析采集的运动捕捉数据计算髋关节和膝关节的运动学参数。使用线性混合模型分析运动学和患者报告的结局测量数据。统计参数分析补充了运动学的主要分析。
与翻修组相比，初次组患者术前患者报告的结局测量结果较差。两组之间的步行速度没有差异。与初次组相比，翻修组在术后3个月和12个月时步态后期站立阶段的髋关节伸展分别低9°和5°。这些差异无统计学意义，但效应量的大小值得注意，提示存在功能缺陷（Cohen's值分别为0.64和0.54）。
采用保留臀肌的扩大后外侧入路进行翻修THA，在术后12个月内可能能够实现与初次THA相似的患者报告结局和步态结果。
