保留关节的髋关节手术会影响后续的全髋关节置换术吗?并发症、功能结果和存活率的荟萃分析。

IF 1.8 Q2 ORTHOPEDICS
SICOT-J Pub Date : 2024-01-01 Epub Date: 2024-06-07 DOI:10.1051/sicotj/2024018
En Lin Goh, Oliver R Boughton, Thomas Donnelly, Colin G Murphy, James Cashman, Connor Green
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引用次数: 0

摘要

背景:保留关节的髋关节手术有助于缓解疼痛并推迟长期关节置换的需要。以往的研究尚未发现会影响全髋关节置换术(THA)后疗效的手术。本荟萃分析旨在评估保留关节的髋关节手术对后续全髋关节置换术后疗效的影响:方法:检索 MEDLINE、EMBASE 和 Scopus 数据库,检索时间从开始日期起至 2024 年 2 月。所有比较股骨或骨盆曾接受过手术(PS)和未接受过手术(NPS)的患者接受 THA 后的疗效的研究均被纳入。研究提取了手术时间、失血量、术中和术后并发症、功能结果和植入物存活率等方面的数据:结果:共纳入16项研究,2576名患者(PS=939人,NPS=1637人)。PS组患者的手术时间明显更长[MD:8.1,95% CI:4.6-11.6],失血量明显更多[MD:167.8,95% CI:135.6-200.0],术中假体周围骨折的风险更高[RR:1.9,95% CI:1.2-3.0],特别是之前进行过股骨截骨术的患者。两组在脱位风险[RR:1.8,95% CI:1.0-3.2]、假体松动[RR:1.0,95% CI:0.7-1.5]或翻修手术[RR:1.3,95% CI:1.0-1.7]方面没有差异。PS组的功能结果改善明显较差[MD:-5.6,95% CI:-7.6-(-3.5)],特别是在髋臼截骨术之前。两组患者一年后的植入物存活率相当[HR:1.9,95% CI:0.6-6.2],但PS组患者五年后的植入物存活率明显低于PS组[HR:2.5,95% CI:1.4-4.7],尤其是股骨截骨术前:结论:保留关节的髋关节手术与更大的术中挑战和并发症相关。在后续关节置换术中,先前的髋臼手术会影响功能结果,而先前的股骨手术则会影响植入物的存活率。小儿髋关节病变的形态学后遗症导致的髋关节疼痛可能会使年幼的孩子变得衰弱。此时的手术决策需要考虑在幼年时植入的全髋关节置换术的存活率,以及保留髋关节手术对进一步全髋关节置换术的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do joint-preserving hip procedures compromise subsequent total hip arthroplasty? A meta-analysis of complications, functional outcome and survivorship.

Background: Joint-preserving hip operations can help relieve pain and delay the need for long-term joint arthroplasty. Previous research has not identified procedures that can compromise outcomes following total hip arthroplasty (THA). This meta-analysis aims to evaluate the effect of joint-preserving hip operations on outcomes following subsequent THA.

Methods: MEDLINE, EMBASE and Scopus databases were searched from the date of inception until February 2024. All studies comparing outcomes following THA in individuals with (PS) and without prior surgery (NPS) of the femur or pelvis were included. Data on operative time, blood loss, intra- and post-operative complications, functional outcomes, and implant survivorship were extracted.

Results: 16 studies, comprising 2576 patients were included (PS = 939, NPS = 1637). The PS group was associated with significantly longer operative time [MD: 8.1, 95% CI: 4.6-11.6], significantly greater blood loss [MD: 167.8, 95% CI: 135.6-200.0], and a higher risk of intra-operative peri-prosthetic fracture [RR: 1.9, 95% CI: 1.2-3.0], specifically, with prior femoral osteotomy. There were no differences in terms of risks of dislocation [RR: 1.8, 95% CI: 1.0-3.2], implant loosening [RR: 1.0, 95% CI: 0.7-1.5], or revision surgery [RR: 1.3, 95% CI: 1.0-1.7] between the two groups. The PS group was associated with significantly poorer improvements in functional outcome [MD: -5.6, 95% CI: -7.6-(-3.5)], specifically, with prior acetabular osteotomy. Implant survivorship in the two groups was comparable after one year [HR: 1.9, 95% CI: 0.6-6.2] but significantly inferior in the PS group after five years [HR: 2.5, 95% CI: 1.4-4.7], specifically, with prior femoral osteotomy.

Conclusion: Joint-preserving hip operations are associated with greater intra-operative challenges and complications. In subsequent joint arthroplasty, prior acetabular procedures affect functional outcomes while prior femoral procedures influence implant survivorship. Hip pain due to the morphological sequelae of pediatric hip pathology can be debilitating at a young age. Surgical decision-making at that time needs to consider the survivorship of a THA implanted at that young age against the consequences of hip preservation surgery on further THA.

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来源期刊
SICOT-J
SICOT-J ORTHOPEDICS-
CiteScore
3.20
自引率
12.50%
发文量
44
审稿时长
14 weeks
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