骨水泥型与非骨水泥型全髋关节置换术的围手术期及短期疗效：一项回顾性倾向评分匹配分析
Perioperative and short-term outcomes of cemented versus cementless total hip arthroplasty: a retrospective propensity-matched analysis.
作者信息
Haider Muhammad A, Garry Conor, Rajahraman Vinaya, Chau Isabelle, Schwarzkopf Ran, Davidovitch Roy I, Macaulay William
机构信息
Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
出版信息
Arch Orthop Trauma Surg. 2024 Dec 12;145(1):15. doi: 10.1007/s00402-024-05709-4.
BACKGROUND
Cement fixation for total hip arthroplasty (THA) remains a controversial topic. While cemented stems are associated with lower risk of periprosthetic fractures (PPF), cementless stems may offer superior biological fixation. This study analyzed peri-operative and short-term outcomes of cemented vs. cementless stem fixation in THA.
METHODS
A retrospective review was conducted on 15,012 patients who underwent primary elective THA at an academic medical center from 2011 to 2021. Of these patients, 429 were cemented. Patients were stratified into 3 age cohorts (25-69, 70-79 and ≥ 80 years). Cemented stem patients were 1:1 propensity-score matched to cementless stem patients for baseline characteristics. Perioperative and short-term outcomes were compared.
RESULTS
The mean operative time for cemented cases was significantly longer across all age cohorts (25-69, P = 0.005; 70-79, P < 0.001; ≥80, P < 0.001). In the 70-79 and ≥ 80 cohorts, cemented patients demonstrated a significantly shorter length of stay (LOS) compared to cementless patients (2.2 vs. 2.6 days, P = 0.017; 3.0 vs. 3.4, P = 0.041, respectively). In the 70-79 and ≥ 80 cohorts, cemented patients were significantly more likely to be discharged home when compared to cementless patients (88.2 vs. 80.5%, P = 0.031; 64.0 vs. 54.2%, P = 0.046, respectively). Across age cohorts, there were no differences in all-cause revision rates (Cohort 1: 5.4% vs. 1.1%, P = 0.108; Cohort 2: 3.0% vs. 1.8%, P = 0.362; Cohort 3: 1.8% vs. 1.2%, P = 0.714). The ≥ 80 cohort demonstrated increased rates of PPF in the cementless cohort compared to cemented (1.2 vs. 0%, P = 0.082, respectively), but it did not reach significance.
CONCLUSION
Patient age has a substantial impact on perioperative outcomes following cemented versus cementless stem THA. Patients > 70 with a cemented femoral stem had improved perioperative outcomes such as shorter LOS, increased discharge to home and reduced rates of PPF compared to their cementless stem counterparts. Patient age should be considered prior to selecting a stem fixation strategy.
LEVEL OF EVIDENCE
III, Therapeutic Study.
背景
全髋关节置换术（THA）的骨水泥固定仍然是一个有争议的话题。虽然骨水泥型股骨柄假体周围骨折（PPF）风险较低，但非骨水泥型股骨柄假体可能提供更好的生物学固定。本研究分析了THA中骨水泥型与非骨水泥型股骨柄假体固定的围手术期和短期结果。
方法
对2011年至2021年在一家学术医疗中心接受初次择期THA的15012例患者进行回顾性研究。其中，429例采用骨水泥固定。患者被分为3个年龄组（25 - 69岁、70 - 79岁和≥80岁）。根据倾向得分将骨水泥型股骨柄假体患者与非骨水泥型股骨柄假体患者按1:1匹配基线特征。比较围手术期和短期结果。
结果
在所有年龄组中，骨水泥固定病例的平均手术时间显著更长（25 - 69岁，P = 0.005；70 - 79岁，P < 0.001；≥80岁，P < 0.001）。在70 - 79岁和≥80岁年龄组中，与非骨水泥型股骨柄假体患者相比，骨水泥固定患者的住院时间显著更短（分别为2.2天对2.6天，P = 0.017；3.0天对3.4天，P = 0.041）。在70 - 79岁和≥80岁年龄组中，与非骨水泥型股骨柄假体患者相比，骨水泥固定患者出院回家的可能性显著更高（分别为88.2%对80.5%，P = 0.031；64.0%对54.2%，P = 0.046）。在各年龄组中，全因翻修率无差异（第1组：5.4%对1.1%，P = 0.108；第2组：3.0%对1.8%，P = 0.362；第3组：1.8%对1.2%，P = 0.714）。≥80岁年龄组中，非骨水泥型股骨柄假体组的PPF发生率高于骨水泥固定组（分别为1.2%对0%，P = 0.082），但未达到统计学意义。
结论
患者年龄对骨水泥型与非骨水泥型股骨柄假体THA后的围手术期结果有重大影响。与非骨水泥型股骨柄假体患者相比，年龄>70岁且采用骨水泥固定股骨柄的患者围手术期结果更好，如住院时间更短、出院回家比例增加以及PPF发生率降低。在选择股骨柄固定策略之前应考虑患者年龄。
证据级别
III，治疗性研究。
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