65岁以上患者的全髋关节置换术与髋关节表面置换术：患者报告结果的倾向评分匹配比较

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2025-05-29 DOI:10.1016/j.artd.2025.101721

Zachary Wong BS , Anand Saluja BA , Louis Andrew Jordan MS , Jonathan Spaan MS , Edwin Su MD

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引用次数: 0

摘要

髋关节表面置换术（HRA）作为全髋关节置换术（THA）的替代方案越来越受欢迎，但主要用于具有足够骨储备和渴望恢复高水平体力活动的年轻患者。虽然HRA植入物的机械结构允许保留股骨颈和更多的解剖负重分布，但其在老年患者，特别是65岁或以上患者中的可行性存在问题。我们进行了这项研究，比较HRA和THA在老年患者人群中的结果，特别关注患者报告的结果测量。方法对65岁及以上经后路行HRA或THA的患者进行回顾性倾向匹配研究。患者根据年龄、体重指数和种族按1:1的比例进行匹配。在术前、6周、1年和至少2年的随访中比较患者报告的结果测量，包括髋关节残疾和骨关节炎结果评分、关节置换术、下肢活动量表、视觉模拟量表疼痛评分和改良Harris髋关节评分。结果两组共纳入70例患者。HRA患者在1年和最后随访时表现出明显更高的髋关节残疾和骨关节炎结局评分、关节置换术和下肢活动量表评分。在最后的随访中，HRA患者的视觉模拟量表疼痛评分较低，改良Harris髋关节评分较高。在HRA组中没有出现翻修，而在THA组中有一例因感染而翻修。结论：在精心挑选的65岁及以上患者中，HRA可以提供与THA相当或更好的结果。然而，在HRA和THA之间的决定应个体化，考虑患者因素和潜在风险。

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Total Hip Arthroplasty vs Hip Resurfacing in Patients Over 65: A Propensity Score–Matched Comparison of Patient-Reported Outcomes

Background

Hip-resurfacing arthroplasty (HRA) has grown in popularity as an alternative to total hip arthroplasty (THA) but is primarily utilized and indicated in younger patients with sufficient bone stock and aspirations of returning to higher level of physical activity. While the mechanical structure of HRA implants allows for sparing of the femoral neck and more anatomical weight-bearing distribution, questions surround its viability in older patients, specifically those aged 65 years or older. We undertook this study to compare the results of HRA vs THA in a population of older patients, with specific focus on patient-reported outcome measures.

Methods

A retrospective, propensity-matched study was conducted on patients aged 65 years or older who underwent either HRA or THA via posterior approach. Patients were matched in a 1:1 ratio based on age, body mass index, and race. Patient-reported outcome measures, including Hip Disability and Osteoarthritis Outcome Score Joint Replacement, Lower Extremity Activity Scale, Visual Analog Scale pain scores, and modified Harris Hip Score were compared at preoperative, 6-week, 1-year, and minimum 2-year follow-ups.

Results

Seventy patients in each group were included. HRA patients demonstrated significantly higher Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Lower Extremity Activity Scale scores at 1-year and final follow-ups. Visual Analog Scale pain scores were lower, and modified Harris Hip Score was higher for HRA patients at the final follow-up. No revisions were reported in the HRA group while one revision due to infection occurred in the THA group.

Conclusions

In carefully selected patients aged 65 years or older, HRA can provide comparable or superior outcomes to THA. However, the decision between HRA and THA should be individualized, considering patient factors and potential risks.

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来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.