Is operative revision associated with favourable clinical outcomes in arthrofibrosis following total hip arthroplasty (THA)? A retrospective, single-centre data analysis of forty two cases.
Christian Lausmann, Navid Memarnia, Jochen Salber, Amir Sandiford, Mustafa Citak, Thorsten Gehrke, Philip Linke
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Abstract
Purpose: There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA.
Methods: This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3 L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55.
Results: Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4 kg vs. 78.7 kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.
Conclusion: Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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