非肿瘤条件下全股关节置换术的当代结果。

IF 4.9 1区 医学 Q1 ORTHOPEDICS
Aaron R Owen, Jacob W Bettencourt, Cody C Wyles, Nicholas A Bedard, Charles P Hannon, Daniel J Berry, Matthew P Abdel
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引用次数: 0

摘要

目的:全股关节置换术(tfa)在非肿瘤性环境下的当代疗效有限。本研究旨在评估非肿瘤条件下与tfa相关的种植体无翻修和再手术存活、临床结果和放射学结果。方法:我们通过我们的机构总联合登记处确定了2007年1月1日至2021年12月31日期间接受tfa治疗的24例患者。患者的平均年龄为66岁(48 - 83岁),平均BMI为33 kg/m2(21 - 54),中位随访时间为4年(IQR 2 - 5)。使用的轴承包括8个平面聚乙烯轴承,7个双活动结构,6个约束衬垫和3个换脸衬垫。在24例患者中,17例先前记录的假体周围关节感染(PJI), 12例在tfa后接受了慢性抗生素抑制治疗。结果:2年、5年和10年无任何修改的生存率分别为66%、51%和34%。共有12次翻修:髋关节脱位5次,PJI 4次,无菌胫骨松动1次,假膝脱位1次,髋臼松动伴骨盆不连续1次。2年、5年和10年无再手术生存率分别为53%、47%和34%。除了所述的TFA修订外,1例患者需要切开复位髋关节脱位,2例患者需要浅表冲洗和清创处理伤口并发症。Harris髋关节平均评分从48分提高到69分(p = 0.002),膝关节社会评分从56分提高到71分(p = 0.110)。在最后的随访中,20名患者原位接受了tfa治疗,但有4名患者因难治性感染而接受了髋关节脱臼治疗。在最后的随访中,除了一个胫骨和所有未翻修的髋臼外,所有的胫骨和髋臼部件在放射学上都得到了很好的固定。结论:在非肿瘤情况下使用tfa,主要用于挽救有先前PJI的多次翻修髋关节,无任何翻修的5年生存率较低,为51%,主要用于髋关节脱位和感染。然而,在这个具有挑战性的患者队列中,临床结果有所改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Contemporary results of total femoral arthroplasties for non-oncological conditions.

Aims: Contemporary outcomes of total femoral arthroplasties (TFAs) in the non-oncological setting are limited. This study aimed to assess implant survival free from revision and reoperation, clinical outcomes, and radiological results associated with TFAs for non-oncological conditions.

Methods: We identified 24 patients who received TFAs between 1 January 2007 and 31 December 2021 through our institutional total joint registry. The patients' mean age was 66 years (48 to 83), mean BMI was 33 kg/m2 (21 to 54), and median follow-up was four years (IQR 2 to 5). Bearings used included eight flat-faced polyethylene bearings, seven dual-mobility constructs, six constrained liners, and three face-changing liners. Of the 24 patients, 17 had a previously documented periprosthetic joint infection (PJI) and 12 were treated with chronic antibiotic suppression following their TFAs.

Results: The two-, five-, and ten-year survivals free of any revision were 66%, 51%, and 34%, respectively. There were 12 revisions: five for hip dislocation, four for PJI, one for aseptic tibial loosening, one for prosthetic knee dislocation, and one for acetabular loosening with pelvic discontinuity. The two-, five-, and ten-year survivals free of any reoperation were 53%, 47%, and 34%, respectively. In addition to the stated TFA revisions, one patient required open reduction of a hip dislocation, and two patients required superficial irrigation and debridement procedures for wound complications. Mean Harris Hip Scores improved from a mean score of 48 to 69 (p = 0.002), and Knee Society Scores improved from a mean score of 56 to 71 (p = 0.110). At final follow-up, 20 patients had TFAs in situ, but four patients had been treated with hip disarticulation due to recalcitrant infection. All but one tibial and all non-revised acetabular components were radiologically well-fixed at final follow-up.

Conclusion: The use of TFAs in the non-oncological setting, mostly for salvage of multiply revised hips with previous PJI, had a low five-year survival free from any revision of 51%, mostly for hip dislocation and infection. Nevertheless, clinical outcomes improved in this challenging cohort of patients.

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来源期刊
Bone & Joint Journal
Bone & Joint Journal ORTHOPEDICS-SURGERY
CiteScore
9.40
自引率
10.90%
发文量
318
期刊介绍: We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.
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