一期全髋关节置换术和对侧髋关节镜治疗双侧股髋臼撞击和骨关节炎的临床试验

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-03-15 DOI:10.1016/j.jor.2025.03.012

Filippo Migliorini , Francesco Coppola , Marco Rosolani , Alessio D'Addona , Vincenzo Di Francia , Guido Grappiolo , Federico Della Rocca

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引用次数: 0

摘要

FAI合并骨关节炎（OA）的cam形态学处理存在争议。然而，目前的手术指征正在变得过时，髋关节镜检查在不同的环境中传播。目前的临床试验评估了一期单侧髋关节镜检查和对侧全髋关节置换术（THA）对伴有唇部撕裂和早期和晚期OA的双侧cam畸形患者的疗效。结果感兴趣的是患者报告的结果测量（PROMs）和并发症发生率。方法前瞻性邀请所有接受一期THA和对侧髋关节镜治疗症状性髋部畸形的患者参与本研究。在透视控制下，患者在牵引床上仰卧位进行关节镜检查。使用了三个标准门户。检查关节内关节间隙，选择性清除髋臼唇周围病变。行唇裂切除术，用生物可吸收锚清除和修复唇裂。关节镜检查后，将患者置于侧位，采用微创后外侧入路行THA。所有患者均接受陶瓷头和维生素e增强聚乙烯（GTS, Zimmer Biomet，美国或3C， Link，德国）的未胶合短茎。结果16例患者均为男性，平均年龄41岁±7.9岁。平均随访时间为4.2±1.3年（2 ~ 6年）。所有患者在1个月内恢复正常生活。从基线到最后一次随访，所有患者的PROMs均有统计学意义显著增加。没有患者出现严重或轻微的并发症。一名患者在关节镜检查后5年因骨关节炎的症状和影像学进展需要THA。没有其他患者进展到THA。没有患者因关节镜检查失败而接受翻修手术。结论一期关节镜和对侧关节置换术分别是治疗FAI合并早期和轻至重度OA的有效方法。

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One stage total hip arthroplasty and contralateral hip arthroscopy for bilateral femoroacetabular impingement and osteoarthritis: A clinical trial

Introduction

The management of cam morphology of FAI associated with osteoarthritis (OA) is debated. However, current surgical indications are becoming obsolete, and hip arthroscopy spreads in different settings. The present clinical trial evaluated the outcome of one-stage unilateral hip arthroscopy and contralateral total hip arthroplasty (THA) in patients with bilateral cam deformity associated with labral tears and early and advanced OA stages, respectively. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of complications.

Methods

All patients who underwent one-stage THA and contralateral hip arthroscopic for symptomatic cam deformity were prospectively invited to participate in the present study. Arthroscopies were performed first with patients in a supine position on a traction bed under fluoroscopic control. Three standard portals were used. The intraarticular joint space was inspected, and the peripheral acetabular labral lesions were selectively debrided. Cam bunectomy was performed, and labral tears were debrided and repaired using bio-resorbable anchors. After arthroscopy, patients were positioned in a lateral position, and THA was performed using a minimally invasive posterolateral approach. All patients received uncemented short stems with ceramic heads and vitamin-E augmented polyethylene (GTS, Zimmer Biomet, United States or 3C, Link, Germany).

Results

All 16 patients were men, with a mean age of 41 years ±7.9. The mean length of the follow-up was 4.2 ± 1.3 years (range, 2 to 6). All patients returned to their normal daily activities within one month. PROMs were statistically significantly increased from baseline to the last follow-up in all patients. No patient experienced minor or major complications. One patient required THA five years after arthroscopy for symptomatic and radiographic progression of osteoarthritis. No other patients progressed to THA. No patient underwent revision surgery for failed arthroscopy.

Conclusion

One-stage arthroscopy and contralateral arthroplasty are effective in managing FAI combined with early and mild to severe OA, respectively.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.