Is Patient Selection Important for Hip Resurfacing?
Is Patient Selection Important for Hip Resurfacing?
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DOI：
10.1007/s11999-008-0558-z
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发表时间：
2009-01-01
影响因子：
4.2
通讯作者：
Barrack, Robert L.
中科院分区：
文献类型：
--
作者：
Nunley, Ryan M.;Della Valle, Craig J.;Barrack, Robert L.
对于年轻活跃的患者，髋关节置换术的最佳植入物选择仍然存在争议。由于植入物设计和制造的改进、更好的材料、增强的植入物固定、相对于传统全髋关节置换术的理论优势以及最近美国食品药品监督管理局批准的两种器械，金属对金属髋关节表面置换术重新受到关注。最近的研究表明，短期和中期临床结果（1- 10年随访）令人满意，并发症发生率低，但该手术存在学习曲线，需要更广泛的手术方法，长期结果尚未确定。适当的患者选择可能有助于避免并发症并改善患者结局。文献中的患者选择标准似乎主要基于理论考虑，对患者风险分层没有任何共识。髋关节表面置换最常见的并发症包括股骨颈骨折、髋臼部件松动、金属过敏、脱位和神经损伤。在临床评价时，患者年龄、性别、诊断、骨密度、质量和形态、活动水平、腿长、肾功能和金属过敏是考虑患者进行髋关节表面置换的重要因素。根据我们的回顾，我们认为髋关节表面置换的最佳候选者是65岁以下骨关节炎和相对正常的骨形态的男性。证据等级：V级，预后研究。有关证据等级的完整描述，请参见作者指南。
The optimal implant option for hip arthroplasty in the young, active patient remains controversial. There has been renewed interest for metal-on-metal hip resurfacing due to improved design and manufacturing of implants, better materials, enhanced implant fixation, theoretical advantages over conventional total hip arthroplasty, and recent Food and Drug Administration approval of two devices. Recent studies indicate satisfactory short- and midterm clinical results (1- to 10-year followup) with low complication rates, but there is a learning curve associated with this procedure, a more extensive surgical approach is necessary, and long-term results have yet to be determined. Proper patient selection may help avoid complications and improve patient outcomes. Patient selection criteria in the literature appear based predominantly on theoretical considerations without any consensus on stratifying patient risk. The most commonly reported complications encountered with hip resurfacing include femoral neck fracture, acetabular component loosening, metal hypersensitivity, dislocation, and nerve injury. At the time of clinical evaluation, patient age; gender; diagnosis; bone density, quality, and morphology; activity level; leg lengths; renal function; and metal hypersensitivity are important factors when considering a patient for hip resurfacing. Based on our review, we believe the best candidates for hip resurfacing are men under age 65 with osteoarthritis and relatively normal bony morphology.Level of Evidence: Level V, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.