Salvini Matteo, Malerba Giuseppe, Meschini Cesare, El Motassime Alessandro, Venturini Edoardo, Campanacci Domenico Andrea, Muratori Francesco, Checcucci Simone, Scanferla Roberto, Vitiello Raffaele, Maccauro Giulio
Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 8, Rome, 00168, Italy.
J Orthop Surg Res. 2025 May 26;20(1):515. doi: 10.1186/s13018-025-05910-0.
This study aimed to evaluate the outcomes and complications associated with proximal femur replacement (PFR) in patients undergoing treatment for primary bone tumors or metastatic lesions. This research specifically compared modular hemiarthroplasty (HA) and total hip arthroplasty (THA) to ascertain the optimal approach regarding functionality and postoperative complications.
A retrospective multicenter review was conducted involving 85 patients who underwent prosthetic femoral reconstruction (PFR) between the years 2015 and 2022 at two specialized medical centers. The patients were classified into two groups: 69 individuals received HA (Group A), while 16 individuals underwent THA (Group B). Outcomes were appraised utilizing the Harris Hip Score (HHS) and the Musculoskeletal Tumor Society (MSTS) score at three months post-surgery. Furthermore, the study assessed the rates of complications.
The overall complication rate was significantly lower in HA, at 24.6%), compared to THA, at 56.3% (p = 0.03). Infection rates were substantially higher in THA, reaching 37%, as opposed to HA, which recorded a rate of 6% (p = 0.002). Although dislocation rates were elevated in THA at 25%, compared to HA at 13%, this difference did not attain statistical significance (p = 0.2). Functional outcomes revealed no significant discrepancies, with HHS and MSTS scores being comparable across both groups (HHS: HA 62 ± 25 versus THA 61 ± 16, p = 0.9; MSTS: HA 17 ± 9 versus THA 14 ± 6, p = 0.5). Logistic regression analysis identified THA as a significant risk factor for infection (odds ratio [OR] = 45.3, p = 0.008) and dislocation (OR = 6.4, p = 0.05).
Proximal femur replacement with modular hemiarthroplasty appears to provide a safer alternative to total hip arthroplasty, characterized by a lower incidence of complications and comparable functional outcomes.
本研究旨在评估接受原发性骨肿瘤或转移性病变治疗的患者行股骨近端置换术（PFR）的疗效和并发症。本研究特别比较了组合式半髋关节置换术（HA）和全髋关节置换术（THA），以确定在功能和术后并发症方面的最佳方法。
进行了一项回顾性多中心研究，纳入了2015年至2022年间在两个专业医疗中心接受人工股骨重建（PFR）的85例患者。患者分为两组：69例接受HA（A组），16例接受THA（B组）。在术后三个月，使用Harris髋关节评分（HHS）和肌肉骨骼肿瘤学会（MSTS）评分评估疗效。此外，该研究还评估了并发症发生率。
HA组的总体并发症发生率显著低于THA组，分别为24.6%和56.3%（p = 0.03）。THA组的感染率显著更高，达到37%，而HA组为6%（p = 0.002）。虽然THA组的脱位率为25%，高于HA组的13%，但这种差异无统计学意义（p = 0.2）。功能结果显示无显著差异，两组的HHS和MSTS评分相当（HHS：HA组62±25，THA组61±16，p = 0.9；MSTS：HA组17±9，THA组14±6，p = 0.5）。逻辑回归分析确定THA是感染（比值比[OR]=45.3，p = 0.008）和脱位（OR = 6.4，p = 0.05）的显著危险因素。
组合式半髋关节置换术进行股骨近端置换似乎是全髋关节置换术的一种更安全的替代方法，其并发症发生率较低，功能结果相当。
