Abstract：
BACKGROUND: Total hip arthroplasty (THA) is often performed in symptomatic patients who have hip dysplasia and do not qualify for periacetabular osteotomy. The impact of osteoarthritis (OA) severity on postoperative outcomes in dysplasia patients who undergo THA is not well described. We hypothesized that dysplasia patients who have mild OA have slower initial recovery postoperatively but similar one-year patient-reported outcome measures (PROMs) compared to dysplasia patients who have severe OA.
METHODS: We performed a retrospective review at a single academic institution over a 6-year period of patients who have dysplasia who underwent THA compared to patients who have primary OA who underwent THA. There were 263 patients who had dysplasia, compared to 1,225 THA patients who did not have dysplasia. Within the dysplasia cohort, we compared PROMs stratified by dysplasia and OA severity. The diagnosis of dysplasia was verified using the radiographic lateral center edge angle. A minimum one-year follow-up was required. The PROMs were collected through one year postoperatively. Logistic and linear regression models were used, adjusting for age, sex, body mass index, and Charlson comorbidity index.
RESULTS: No significant differences were found in postoperative PROMs or revision rates (P = .58). When stratified by dysplasia severity, patients who had lower lateral center edge angle had more improvement in physical function scores from preoperative to 2 weeks (P < .01) and higher physical function scores at 2 weeks (P = .03). When stratified by OA severity, patients who had a worse Tönnis score had more improvement in physical function scores from preoperative to 2 weeks (P < .01). Recovery curves in dysplasia patients based on dysplasia and OA severity were not significantly different at 6 weeks, 1 year, and 2 years postoperative.
CONCLUSIONS: Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. We believe that THA is a reasonable surgical intervention for symptomatic dysplasia patients who have mild arthritis and do not qualify for periacetabular osteotomy.
METHODS: We performed a retrospective review at a single academic institution over a 6-year period of patients who have dysplasia who underwent THA compared to patients who have primary OA who underwent THA. There were 263 patients who had dysplasia, compared to 1,225 THA patients who did not have dysplasia. Within the dysplasia cohort, we compared PROMs stratified by dysplasia and OA severity. The diagnosis of dysplasia was verified using the radiographic lateral center edge angle. A minimum one-year follow-up was required. The PROMs were collected through one year postoperatively. Logistic and linear regression models were used, adjusting for age, sex, body mass index, and Charlson comorbidity index.
RESULTS: No significant differences were found in postoperative PROMs or revision rates (P = .58). When stratified by dysplasia severity, patients who had lower lateral center edge angle had more improvement in physical function scores from preoperative to 2 weeks (P < .01) and higher physical function scores at 2 weeks (P = .03). When stratified by OA severity, patients who had a worse Tönnis score had more improvement in physical function scores from preoperative to 2 weeks (P < .01). Recovery curves in dysplasia patients based on dysplasia and OA severity were not significantly different at 6 weeks, 1 year, and 2 years postoperative.
CONCLUSIONS: Patients who had hip dysplasia and mild OA had similar recovery curves compared to those who had severe OA or who did not have dysplasia. We believe that THA is a reasonable surgical intervention for symptomatic dysplasia patients who have mild arthritis and do not qualify for periacetabular osteotomy.
摘要：
背景：全髋关节置换术（THA）通常在有髋关节发育不良且不符合髋臼周围截骨术（PAO）的症状患者中进行。骨关节炎（OA）严重程度对接受THA的发育不良患者术后预后的影响尚未得到很好的描述。我们假设患有轻度OA的发育不良患者术后初始恢复较慢，但与患有严重OA的发育不良患者相比,患者报告的一年结局指标(PROM)相似.
方法：我们在一个学术机构进行了为期6年的回顾性研究，研究对象是接受THA的发育不良患者与接受THA的原发性OA患者。有263名患有发育不良的患者与1,225名没有发育不良的THA患者进行比较。在发育不良队列中，我们比较了按发育不良和OA严重程度分层的PROMs。异型增生的诊断使用放射学横向中心边缘角（LCEA）进行验证。需要至少一年的随访。术后一年收集PROM。使用Logistic和线性回归模型，调整年龄，性别,身体质量指数,和Charlson合并症指数。
结果：术后PR0M和翻修率无显著差异（P=0.58）。当按发育不良严重程度分层时，LCEA水平较低的患者在术前至2周时的躯体功能评分改善更多(P<0.01),2周时的躯体功能评分较高(P=0.03).当按OA严重程度分层时，Tönnis评分较差的患者在术前至2周时的身体功能评分改善更多(P<0.01).基于发育不良和OA严重程度的发育不良患者的恢复曲线在6周时没有显着差异，1年,术后2年。
结论：患有髋关节发育不良和轻度OA的患者与患有重度OA或没有发育不良的患者相比，恢复曲线相似。我们认为，THA是一种合理的手术干预措施，适用于轻度关节炎且不符合PAO资格的有症状的发育不良患者。
方法：我们在一个学术机构进行了为期6年的回顾性研究，研究对象是接受THA的发育不良患者与接受THA的原发性OA患者。有263名患有发育不良的患者与1,225名没有发育不良的THA患者进行比较。在发育不良队列中，我们比较了按发育不良和OA严重程度分层的PROMs。异型增生的诊断使用放射学横向中心边缘角（LCEA）进行验证。需要至少一年的随访。术后一年收集PROM。使用Logistic和线性回归模型，调整年龄，性别,身体质量指数,和Charlson合并症指数。
结果：术后PR0M和翻修率无显著差异（P=0.58）。当按发育不良严重程度分层时，LCEA水平较低的患者在术前至2周时的躯体功能评分改善更多(P<0.01),2周时的躯体功能评分较高(P=0.03).当按OA严重程度分层时，Tönnis评分较差的患者在术前至2周时的身体功能评分改善更多(P<0.01).基于发育不良和OA严重程度的发育不良患者的恢复曲线在6周时没有显着差异，1年,术后2年。
结论：患有髋关节发育不良和轻度OA的患者与患有重度OA或没有发育不良的患者相比，恢复曲线相似。我们认为，THA是一种合理的手术干预措施，适用于轻度关节炎且不符合PAO资格的有症状的发育不良患者。
