来源：304关节学术

译者：马云青

整理：骨科在线

来自美国的Angerame MR，Fehring TK，Masonis JL等人发表于《J Arthroplasty》杂志的一项研究显示，全髋关节置换术(THA)手术直接前路(DAA)有较高的股骨假体松动率，而后路(PA)有较高的不稳发生率；但总翻修率在各入路之间没有统计学差异。

随着THA手术的发展，手术入路也在不断创新，但人们对术后早期失败担心越来越大。因此研究人员希望通过对不同手术入路对初次THA分层评估术后早期失败的发生率。

研究人员对2007年至2014年在病例数量较大的医学中心连续完成的初次THA进行回顾性研究。通过手术入路对THA病例进行分层。入路仅包括直接前路(DAA)和后路(PA)，主要评价结果是早期翻修(<5年)。使用SAS软件进行描述性统计分析。

结果显示，2007年至2014年间，总共有6894例初次THA。在2431例采用DAA和4463例采用，总共有103例早期翻修。与PA行THA（1.39%）(P=0.33)DAA行 THA的总体翻修率（1.69%）没有统计学差异。与PA(P=0.0003)DAA入路术后由于股骨假体松动的早期翻修率较高。约35.7%的DAA翻修原因为股骨假体松动，而这一原因在PA入路为8%。DAA入路病例中Dorr A型股骨病例的股骨假体松动率更高(P=0.03)。PA入路更常见的翻修原因是术后不稳定(P=0.04)。在失败时间、髋臼松动、早期假体周围骨折或感染方面，两种入路无差异。

原文摘要

Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?

Background:

In an era of innovation in surgical approaches for total hip arthroplasty (THA), there is concern for increasing trends of early failure. The purpose of this study is to evaluate the incidence of early failure of primary THA stratified by surgical approach.

Methods:

A retrospective review was performed on consecutive primary THAs completed from 2007 to 2014 at a high-volume center. THAs were stratified by surgical approach. Only the direct anterior (DAA) and posterior approaches (PA) were included. The primary outcome measure was early revision (<5 years). Descriptive statistics were performed using SAS software.

Results:

In total, 6894 primary THAs performed between 2007 and 2014 were included. Across 2431 DAA THAs and 4463 PA THAs, there were 103 revisions overall. There was no difference in the overall revision rate for DAA THAs (1.69%) compared to PA THAs (1.39%) (P = .33). The DAA had a higher rate of early revisions for femoral component loosening compared to the PA (P = .0003). About 35.7% of DAA THAs were revised for femoral loosening compared to 8% for the PA (P = .0003). Early failure by femoral loosening occurred more often via the DAA in Dorr A bone (P = .03). The PA had a higher incidence of revision for instability (P = .04). There was no difference in modes of failure with regards to time to failure, acetabular loosening, early periprosthetic fracture, or infection.

Conclusion:

The DAA had a higher incidence of femoral loosening while PA had a higher mode of failure due to instability. Overall revision rates were not statistically different between approaches.

文献出处：

Angerame MR, Fehring TK, Masonis JL, Mason JB, Odum SM, Springer BD. Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?. J Arthroplasty. 2018;33(6):1780-1785. doi:10.1016/j.arth.2018.01.014