Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions
Early to medium-term outcomes of uncemented ceramic-bearing total hip arthroplasty in teenagers for paediatric hip conditions
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DOI：
10.1302/0301-620x.102b11.bjj-2020-0668.r1
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发表时间：
2020-11-01
影响因子：
4.6
通讯作者：
Hashemi-Nejad, A.
中科院分区：
文献类型：
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作者：
Buddhdev, P. K.;Vanhegan, I. S.;Hashemi-Nejad, A.
目标尽管小儿髋关节疾病的治疗取得了进展，但青少年和年轻成人患者仍可能发展为早发性终末期骨关节炎。本研究的目的是解决青少年患者陶瓷轴承全髋关节置换术 (THA) 的适应症和中期结果。方法手术由在三级转诊医院儿科骨科单位工作的一名外科医生进行。对 2003 年至 2017 年所有接受 THA 的青少年患者的数据库进行了查询，并进行了至少 2.3 年的随访。数据采集包括患者人口统计数据、潜在的髋关节病理、既往手术次数以及使用的 THA 假体。获得了机构伦理批准，可以联系患者以了解前瞻性临床结果并获取最新的放射线照片。总共有 51 名患者（35 名女性，16 名男性）植入了 60 个原发髋关节，其中 9 名双侧病例。平均年龄为 16.7 岁（12 至 19），平均随访时间为 9.3 年（2.3 至 16.8）。结果 青少年髋关节置换术最常见的适应症是继发于上股骨骨骺滑脱的股骨头缺血性坏死（31%；n = 16）。总体而言，64% 的患者 (n = 33) 之前接受过多次手术。随访时生存率为 97%；两名患者因无菌性松动而需要翻修（一根股骨柄，一根髋臼假体）。两名患者在关节置换术时均发现髋关节已融合。另外两名患者有射线可透线，但没有症状。在最近的随访中，平均牛津髋关节评分为 44（31 至 48），视觉模拟量表测量值为 1.5，表明功能令人满意。 结论 对这组患者进行的手术可能会因之前多次手术和扭曲的解剖结构而变得复杂，在某些情况下需要定制假肢。我们在这组复杂的患者中展示了良好的结果和较低的翻修率。
AimsDespite advances in the treatment of paediatric hip disease, adolescent and young adult patients can develop early onset end-stage osteoarthritis. The aims of this study were to address the indications and medium-term outcomes for total hip arthroplasty (THA) with ceramic bearings for teenage patients.MethodsSurgery was performed by a single surgeon working in the paediatric orthopaedic unit of a tertiary referral hospital. Databases were interrogated from 2003 to 2017 for all teenage patients undergoing THA with a minimum 2.3 year follow-up. Data capture included patient demographics, the underlying hip pathology, number of previous surgeries, and THA prostheses used. Institutional ethical approval was granted to contact patients for prospective clinical outcomes and obtain up-to-date radiographs. In total, 60 primary hips were implanted in 51 patients (35 female, 16 male) with nine bilateral cases. The mean age was 16.7 years (12 to 19) and mean follow-up was 9.3 years (2.3 to 16.8).ResultsThe most common indication for teenage hip arthroplasty was avascular necrosis secondary to slipped upper femoral epiphysis (31%; n = 16). Overall, 64% of patients (n = 33) had undergone multiple previous operations. The survival at follow-up was 97%; two patients required revision for aseptic loosening (one femoral stem, one acetabular component). Both patients had fused hips noted at the time of arthroplasty. A further two patients had radiolucent lines but were asymptomatic. At latest follow-up the mean Oxford Hip Score was 44 (31 to 48) and a Visual Analogue Scale measurement of 1.5, indicating satisfactory function.ConclusionOperating on this cohort can be complicated by multiple previous surgeries and distorted anatomy, which in some cases require custom-made prostheses. We have demonstrated a good outcome with low revision rate in this complex group of patients.