Wagener Nele, Wu Yinan, Grimberg Alexander, Hipfl Christian, Hardt Sebastian
Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany.
EPRD Deutsches Endoprothesenregister gGmbH, Berlin, Germany.
Bone Jt Open. 2025 Aug 11;6(8):915-923. doi: 10.1302/2633-1462.68.BJO-2025-0067.
Patients with a history of osteotomy or osteosynthesis pose distinct challenges in total hip arthroplasty (THA) due to altered anatomy and biomechanics. Although THA is an established intervention for degenerative hip disease, limited evidence exists on its long-term outcomes in this cohort, especially regarding revision rates, mortality, and complications. This registry study aimed to determine these outcomes using data from a large national registry.
This registry study analyzed data from the German Arthroplasty Registry (EPRD), which captures approximately 70% of all hip arthroplasties in Germany. Among 418,409 patients undergoing THA between November 2012 and March 2024, 5,392 were included after 1:1 Mahalanobis distance matching for age, sex, BMI, and comorbidities: 2,696 patients with a history of osteotomy or osteosynthesis compared with 2,696 patients without. Kaplan-Meier survival curves estimated revision and mortality risks over an eight-year follow-up.
Over eight years, patients with prior osteotomy or osteosynthesis had significantly higher revision (6.8%, n = 183/2,696 vs 3.9%, n = 105/2,696, p = 0.002) and mortality (25.2%, n = 679/2,696 vs 20.4%, n = 550/2,696, p < 0.001) rates than those without prior hip surgery. Infection (17%, n = 22/131 vs 16%, n = 15/94), periprosthetic fracture (14%, n = 18/131 vs 12%, n = 11/94), and dislocation (14%, n = 18/131 vs 8.5%, n=8/94) were leading causes of revision. For cementless femoral components, prior-surgery patients had an eight-year revision rate of 7.3%, n = 143/1,957 compared with 3.6%, n = 71/1,958 (p = 0.003) and a mortality rate of 17.3%, n = 339/1,957 compared with 10.9%, n = 213/1,958 (p < 0.001). For cemented femoral components, revision rates were 4.9%, n = 36/739, compared with 4.7%, n = 35/738 (p = 0.330), and mortality 46.3%, n = 342/739, compared with 43.0%, n = 317/738 (p < 0.001). At one year, the revision rate in the prior-surgery group was already elevated at 3.7% (95% CI 3.1 to 4.5; n = 100/2,696) compared with 2.6% (95% CI 2.0 to 3.3; n = 70/2,696) in controls, diverging further over time.
Patients with prior osteotomy or osteosynthesis undergoing THA face higher long-term revision and mortality risks, particularly with cementless stem fixation. Infection, periprosthetic fracture, and dislocation are key causes of revision.
由于解剖结构和生物力学的改变，有截骨术或骨固定术病史的患者在全髋关节置换术（THA）中面临着独特的挑战。尽管THA是治疗退行性髋关节疾病的既定干预措施，但关于该队列长期预后的证据有限，尤其是翻修率、死亡率和并发症方面。这项注册研究旨在利用来自大型国家注册机构的数据确定这些预后情况。
这项注册研究分析了德国关节置换注册中心（EPRD）的数据，该中心收集了德国约70%的髋关节置换手术数据。在2012年11月至2024年3月期间接受THA的418,409例患者中，经过年龄、性别、体重指数和合并症的1:1马氏距离匹配后，纳入了5392例：2696例有截骨术或骨固定术病史的患者与2696例无该病史的患者进行对比。采用Kaplan-Meier生存曲线估计八年随访期内的翻修和死亡风险。
在八年时间里，有既往截骨术或骨固定术病史的患者的翻修率（6.8%，n = 183/2696 vs 3.9%，n = 105/2696，p = 0.002）和死亡率（25.2%，n = 679/2696 vs 20.4%，n = 550/2696，p < 0.001）显著高于无既往髋关节手术史的患者。感染（17%，n = 22/131 vs 16%，n = 15/94）、假体周围骨折（14%，n = 18/131 vs 12%，n = 11/94）和脱位（14%，n = 18/131 vs 8.5%，n = 8/94）是翻修的主要原因。对于非骨水泥型股骨假体，有手术史的患者八年翻修率为7.3%，n = 143/1957，而对照组为3.6%，n = 71/1958（p = 0.003），死亡率为17.3%，n = 339/1957，对照组为10.9%，n = 213/1958（p < 0.001）。对于骨水泥型股骨假体，翻修率分别为4.9%，n = 36/739和4.7%，n = 35/738（p = 0.330），死亡率分别为46.3%，n = 342/739和43.0%，n = 317/738（p < 0.001）。在一年时，有手术史组的翻修率已升高至3.7%（95%CI 3.1至4.5；n = 100/2696），而对照组为2.6%（95%CI 2.0至3.3；n = 70/2696），且随着时间推移差异进一步扩大。
有既往截骨术或骨固定术病史且接受THA的患者面临更高的长期翻修和死亡风险，尤其是采用非骨水泥柄固定时。感染、假体周围骨折和脱位是翻修的关键原因。
