Kobayashi Seneki, Sugano Nobuhiko, Ando Wataru, Fukushima Wakaba, Kondo Kyoko, Sakai Takashi
The Investigation Committee on Osteonecrosis of the Femoral Head Under the Ministry of Health, Labour and Welfare, Tokyo 100-8959, Japan.
Department of Orthopaedic Surgery, Suwa Red Cross Hospital, Suwa 392-8510, Japan.
Materials (Basel). 2025 May 6;18(9):2125. doi: 10.3390/ma18092125.
A nationwide multicenter follow-up cohort study of hip-replacement arthroplasties performed for nontraumatic osteonecrosis of the femoral head (ONFH) was conducted to clarify factors associated with need for reoperation. We analyzed 7393 arthroplasties including 6284 total hip arthroplasties (THAs), 886 bipolar hemiarthroplasties (BPs), 188 total resurfacing arthroplasties, and 35 hemi-resurfacing arthroplasties (hRSs). The identified risk factors were combined systemic steroid use and excessive alcohol consumption (both ONFH-associated factors), a lateral approach, alumina BPs (aBPs), and hRSs, which were reported previously. The present study performed further analyses separately for THAs and BPs to clarify risk factors in each surgical group. A Cox proportional-hazard model identified the following risk factors: the acetabular-articulating materials of conventional polyethylene (cPE) and metal in the THAs and both ONFH-associated factors, minimum-incision surgery (MIS), and aBPs in the BPs. The risk factors were specific to each surgical group. In the ONFH patients, when performing THA, cPE and metal are not recommended as the acetabular-articulating material. When performing BP, patients with both ONFH-associated factors should be treated carefully, and the employment of MIS and use of aBP are not good strategies.
我们开展了一项针对因非创伤性股骨头坏死（ONFH）而进行髋关节置换术的全国多中心随访队列研究，以明确与再次手术需求相关的因素。我们分析了7393例关节置换术，包括6284例全髋关节置换术（THA）、886例双极半髋关节置换术（BP）、188例全表面置换关节成形术和35例半表面置换关节成形术（hRS）。已确定的风险因素包括联合使用全身性类固醇和过量饮酒（均为与ONFH相关的因素）、外侧入路、氧化铝双极半髋关节置换术（aBP）和hRS，这些因素此前已有报道。本研究针对THA和BP分别进行了进一步分析，以明确每个手术组中的风险因素。Cox比例风险模型确定了以下风险因素：THA中传统聚乙烯（cPE）和金属的髋臼关节面材料，以及BP中的与ONFH相关的因素、微创外科手术（MIS）和aBP。这些风险因素因手术组而异。对于ONFH患者，进行THA时，不建议使用cPE和金属作为髋臼关节面材料。进行BP时，对于同时存在与ONFH相关因素的患者应谨慎治疗，采用MIS和使用aBP并非好的策略。
