H W van Kouswijk, M P A Bus, M G J Gademan, R G H H Nelissen, P B de Witte
{"title":"儿童全髋关节置换术：一项荷兰髋关节置换术登记研究，数据来自283髋。","authors":"H W van Kouswijk, M P A Bus, M G J Gademan, R G H H Nelissen, P B de Witte","doi":"10.2106/JBJS.24.00657","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is rarely performed in pediatric patients and can be challenging in children because of smaller-sized joints, pathomorphological changes around the hip, residual growth, and higher physical demands. Literature on THA outcomes in this unique population is scarce. We aimed to describe characteristics of pediatric patients who underwent THA, 5- and 10-year implant survival, risk factors for revision, and results of patient-reported outcome measures (PROMs) in a large national cohort.</p><p><strong>Methods: </strong>Primary THAs (from 2007 through 2022) in pediatric patients (11 to 18 years of age) for non-oncological indications were extracted from the Dutch Arthroplasty Register (LROI). Implant survival was assessed using Kaplan-Meier survival analyses. Functional, quality-of-life, and pain-related PROM scores were described preoperatively and at 3 and 12 months postoperatively and compared using paired t tests.</p><p><strong>Results: </strong>We included 283 THAs (161 [57%] in female patients) performed in 253 patients. The mean age at surgery (and standard deviation) was 16 ± 1.6 years. The most common indications were osteonecrosis (90 [32%] of the THA procedures), dysplasia (82 [29%]), and osteoarthritis (54 [19%]). The median follow-up was 7 years (range, 2 to 16 years). Fourteen (6% of 234) THAs were revised. The 5- and 10-year cumulative survival rates were 95% (95% confidence interval [CI], 91% to 97%) and 91% (95% CI, 84% to 95%), respectively. There was an insufficient number of events to allow for statistical analyses of potential risk factors for revision. All PROMs had improved significantly at 12 months postoperatively versus preoperatively (p < 0.001).</p><p><strong>Conclusions: </strong>This study, the largest to date on THA in children (≤18 years of age), showed good short- and mid-term THA survival, approaching that among adults. Combined with the positive PROM results, THA appears to be an effective and satisfactory intervention in cases of debilitating pediatric hip disease. Further studies should focus on long-term survival and risk factors for implant failure.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"811-818"},"PeriodicalIF":4.4000,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Total Hip Arthroplasty in Children: A Dutch Arthroplasty Register Study with Data from 283 Hips.\",\"authors\":\"H W van Kouswijk, M P A Bus, M G J Gademan, R G H H Nelissen, P B de Witte\",\"doi\":\"10.2106/JBJS.24.00657\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Total hip arthroplasty (THA) is rarely performed in pediatric patients and can be challenging in children because of smaller-sized joints, pathomorphological changes around the hip, residual growth, and higher physical demands. Literature on THA outcomes in this unique population is scarce. We aimed to describe characteristics of pediatric patients who underwent THA, 5- and 10-year implant survival, risk factors for revision, and results of patient-reported outcome measures (PROMs) in a large national cohort.</p><p><strong>Methods: </strong>Primary THAs (from 2007 through 2022) in pediatric patients (11 to 18 years of age) for non-oncological indications were extracted from the Dutch Arthroplasty Register (LROI). Implant survival was assessed using Kaplan-Meier survival analyses. Functional, quality-of-life, and pain-related PROM scores were described preoperatively and at 3 and 12 months postoperatively and compared using paired t tests.</p><p><strong>Results: </strong>We included 283 THAs (161 [57%] in female patients) performed in 253 patients. The mean age at surgery (and standard deviation) was 16 ± 1.6 years. The most common indications were osteonecrosis (90 [32%] of the THA procedures), dysplasia (82 [29%]), and osteoarthritis (54 [19%]). The median follow-up was 7 years (range, 2 to 16 years). Fourteen (6% of 234) THAs were revised. The 5- and 10-year cumulative survival rates were 95% (95% confidence interval [CI], 91% to 97%) and 91% (95% CI, 84% to 95%), respectively. There was an insufficient number of events to allow for statistical analyses of potential risk factors for revision. All PROMs had improved significantly at 12 months postoperatively versus preoperatively (p < 0.001).</p><p><strong>Conclusions: </strong>This study, the largest to date on THA in children (≤18 years of age), showed good short- and mid-term THA survival, approaching that among adults. Combined with the positive PROM results, THA appears to be an effective and satisfactory intervention in cases of debilitating pediatric hip disease. Further studies should focus on long-term survival and risk factors for implant failure.</p><p><strong>Level of evidence: </strong>Therapeutic Level III . 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Total Hip Arthroplasty in Children: A Dutch Arthroplasty Register Study with Data from 283 Hips.
Background: Total hip arthroplasty (THA) is rarely performed in pediatric patients and can be challenging in children because of smaller-sized joints, pathomorphological changes around the hip, residual growth, and higher physical demands. Literature on THA outcomes in this unique population is scarce. We aimed to describe characteristics of pediatric patients who underwent THA, 5- and 10-year implant survival, risk factors for revision, and results of patient-reported outcome measures (PROMs) in a large national cohort.
Methods: Primary THAs (from 2007 through 2022) in pediatric patients (11 to 18 years of age) for non-oncological indications were extracted from the Dutch Arthroplasty Register (LROI). Implant survival was assessed using Kaplan-Meier survival analyses. Functional, quality-of-life, and pain-related PROM scores were described preoperatively and at 3 and 12 months postoperatively and compared using paired t tests.
Results: We included 283 THAs (161 [57%] in female patients) performed in 253 patients. The mean age at surgery (and standard deviation) was 16 ± 1.6 years. The most common indications were osteonecrosis (90 [32%] of the THA procedures), dysplasia (82 [29%]), and osteoarthritis (54 [19%]). The median follow-up was 7 years (range, 2 to 16 years). Fourteen (6% of 234) THAs were revised. The 5- and 10-year cumulative survival rates were 95% (95% confidence interval [CI], 91% to 97%) and 91% (95% CI, 84% to 95%), respectively. There was an insufficient number of events to allow for statistical analyses of potential risk factors for revision. All PROMs had improved significantly at 12 months postoperatively versus preoperatively (p < 0.001).
Conclusions: This study, the largest to date on THA in children (≤18 years of age), showed good short- and mid-term THA survival, approaching that among adults. Combined with the positive PROM results, THA appears to be an effective and satisfactory intervention in cases of debilitating pediatric hip disease. Further studies should focus on long-term survival and risk factors for implant failure.
Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
期刊介绍：
The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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