通过前路与后路全髋关节置换术进行骨水泥股骨固定的比较:对 60739 例全髋关节置换术的分析。

IF 1.3 4区 医学 Q3 ORTHOPEDICS
HIP International Pub Date : 2024-07-01 Epub Date: 2024-03-26 DOI:10.1177/11207000241239914
Wayne Hoskins, Sophie Corfield, Yi Peng, Stephen E Graves, Roger Bingham
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引用次数: 0

摘要

背景:前路全髋关节置换术(THA)可降低脱位率,但会增加股骨侧并发症,如假体周围骨折和组件松动。骨水泥假体可减少股骨侧并发症,改善前路全髋关节置换术的风险收益比:对澳大利亚国家关节置换登记处的数据进行了分析,对象是2015年1月至2021年12月期间通过前路或后路使用骨水泥抛光股骨柄进行初次THA的患者。主要结果指标是所有原因的累计翻修率(CPR)以及股骨组件松动和骨折的CPR。比较了前路和后路方法的主要结局指标CPR,并根据年龄、性别、ASA评分、体重指数和股骨头大小进行了调整:研究包括60739例使用骨水泥柄的THA(前路10742例,后路49997例)。前路与后路的翻修率差异不大(HR 0.87 (95% CI, 0.74-1.03), p = 0.100)。前路THA因股骨组件松动(HR 5.06 [95% CI, 3.08-8.30],P = 0.001)和脱位/不稳定(HR 0-3个月 0.48 [95% CI, 0.27-0.83],P = 0.008;HR >3个月 0.30 [95% CI, 0.15-0.61],P = 0.975)而导致的翻修率明显更高:结论:采用前路或后路进行骨水泥股骨固定术的总体翻修率没有明显差异。采用前路方法进行骨水泥固定可部分缓解股骨并发症,骨折翻修率无差异,但股骨组件松动率增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A comparison of cemented femoral fixation via anterior versus posterior approach total hip arthroplasty: an analysis of 60,739 total hip arthroplasties.

Background: Anterior approach total hip arthroplasty (THA) decreases the rate of dislocation but increases femoral-sided complications in the way of periprosthetic fractures and component loosening. A cemented prosthesis may reduce femoral-sided complications and improve the risk:benefit profile of anterior approach THA.

Methods: Data from the Australian National Joint Replacement Registry were analysed for patients undergoing primary THA via the anterior or posterior approach using a cemented polished femoral stem from January 2015 to December 2021. The primary outcome measure was the cumulative percent revision (CPR) for all causes and CPR for femoral component loosening and fracture. The CPR for the primary outcome measures were compared between the anterior and posterior approach and adjusted for age, sex, ASA score, BMI and femoral head size.

Results: The study included 60,739 THAs with cemented stems (10,742 anterior, 49,997 posterior). The rate of revision of the anterior versus the posterior approach did not significantly differ (HR 0.87 (95% CI, 0.74-1.03), p = 0.100). Anterior approach THA had a significantly higher rate of revision for femoral component loosening (HR 5.06 [95% CI, 3.08-8.30], p < 0.001); and a decreased rate of revision for infection (HR 0.59 [95% CI, 0.43-0.81], p = 0.001) and dislocation/instability (HR 0-3 months 0.48 [95% CI, 0.27-0.83], p = 0.008; HR >3 months 0.30 [95% CI, 0.15-0.61], p < 0.001). There was no difference in the rate of revision surgery for fracture between the 2 approaches (HR 1.01 [95% CI, 0.71-1.43]), p = 0.975).

Conclusions: There is no significant difference in overall revision rates with cemented femoral fixation performed with an anterior or posterior approach. Cemented fixation performed with the anterior approach partly mitigates femoral complications with no difference in the revision rate for fracture but an increased rate of femoral component loosening.

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来源期刊
HIP International
HIP International 医学-整形外科
CiteScore
4.20
自引率
0.00%
发文量
70
审稿时长
2 months
期刊介绍: HIP International is the official journal of the European Hip Society. It is the only international, peer-reviewed, bi-monthly journal dedicated to diseases of the hip. HIP International considers contributions relating to hip surgery, traumatology of the hip, prosthetic surgery, biomechanics, and basic sciences relating to the hip. HIP International invites reviews from leading specialists with the aim of informing its readers of current evidence-based best practice. The journal also publishes supplements containing proceedings of symposia, special meetings or articles of special educational merit. HIP International is divided into six independent sections led by editors of the highest scientific merit. These sections are: • Biomaterials • Biomechanics • Conservative Hip Surgery • Paediatrics • Primary and Revision Hip Arthroplasty • Traumatology
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