背景:翻修全髋关节置换术(THA)可能很复杂,评估可能的困难对预测手术时间很重要。尚未对预测困难的简单评分进行前瞻性评估。因此,我们为提取和重建困难的术前评估开发了原始分数。这项前瞻性研究的目的是(1)评估评分值与手术时间之间的相关性,(2)判断评分是否预测需要翻修植入物和/或填充材料,(3)判断评分是否预测术中、术后并发症,(4)评价观察者间和观察者间评分的可重复性。
目的:评分是可重复的,并且与手术时间密切相关,从而允许在手术前预测该参数。
方法:对2018年3月至2023年8月进行的103次修订THA程序进行了前瞻性研究。主要结果是手术时间,次要结果是使用翻修植入物,使用填充材料,术中和术后并发症。分数由四名观察员确定,以便评估观察员之间的协议。通过让一名观察者在纳入最后一名患者后第二次确定评分来评估观察者内一致性。分数的最大值为20,可以将手术分类为非常困难,困难,适度困难。
结果:困难组的平均手术时间与评分值相关:136.0±33.9分钟,困难组102.0±34.8min,中度困难组75.4±65.5分钟(p=0.0002)。该分数预测了加强环的使用(40个程序:12/17[70%],11/25[44%],17/61[28%]在非常困难的情况下,困难,和中等困难的群体,分别为;p=0.01)和长茎(20个程序:8/17[47%],7/25[28%],和5/61[8%]的患者在非常困难的,困难,和中等困难的群体,分别为;p<0.001)。分数没有预测填充材料的使用(42个程序:10/17[59%],9/25[36%],和23/61[37%]在非常困难的情况下,困难,和中等困难的群体,分别为;p=0.250)。该评分预测了两种术中并发症(5/17[29%],4/25[16%],和4/61[6%]在非常困难的程序,困难,和中等困难的群体,分别为;p=0.028)和术后并发症(4/17[23%],0/25[0%],6/61[9%]在非常困难的情况下,困难,和中等困难的群体,分别为;p=0.15)。根据Landis-Koch标准,观察员之间的协议很强,Kappa值范围为0.70至0.79[0.57-0.90]。观察者内部协议的kappa值为0.74[0.63-0.85]。
结论:该评分通过增加骨破坏标准来预测手术困难,与广泛使用的修订THA分类相反。此外,评分是可重复的,可以预测手术时间,因此,在术前计划中可能发挥重要作用。
方法:IV;前瞻性观察性非比较研究。
BACKGROUND: Revision total hip arthroplasty (THA) can be complex, and assessing possible difficulties is important to predict the operative time. No simple score for predicting difficulties has been assessed prospectively. We therefore developed an original score for the pre-operative evaluation of extraction and reconstruction difficulties. The objectives of this prospective study were to (1) assess correlations between score values and operative time, (2) determine whether the score predicted the need for revision implants and/or filling material, (3) determine whether the score predicted intra-operative and post-operative complications, and (4) evaluate the inter-observer and intra-observer reproducibility of the score.
OBJECTIVE: The score is reproducible and correlates well with the operative time, thereby allowing prediction of this parameter before surgery.
METHODS: A prospective study of 103 revision THA procedures performed between March 2018 and August 2023 was conducted. The primary outcome was operative time and the secondary outcomes were use of a revision implant, use of filling material, and intra-operative and post-operative complications. The score was determined by four observers to allow evaluation of inter-observer agreement. Intra-observer agreement was assessed by having one of the observers determine the score a second time after inclusion of the last patient. The score has a maximum value of 20 and allows classification of the procedure as very difficult, difficult, and moderately difficult.
RESULTS: Mean operative time correlated with the score value: 136.0 ± 33.9 min in the very difficult group, 102.0 ± 34.8 min in the difficult group, and 75.4 ± 65.5 min in the moderately difficult group (p = 0.0002). The score predicted the use of a reinforcement ring (40 procedures: 12/17 [70%], 11/25 [44%], and 17/61 [28%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.01) and of a long stem (20 procedures: 8/17 [47%], 7/25 [28%], and 5/61 [8%] patients in the very difficult, difficult, and moderately difficult groups, respectively; p < 0.001). The score did not predict the use of filling material (42 procedures: 10/17 [59%], 9/25 [36%], and 23/61 [37%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.250). The score predicted both intra-operative complications (5/17 [29%], 4/25 [16%], and 4/61 [6%] procedures in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.028) and post-operative complications (4/17 [23%], 0/25 [0%], and 6/61 [9%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.15). Inter-observer agreement was strong according to Landis-Koch criteria, with kappa values ranging from 0.70 to 0.79 [0.57-0.90]. The kappa value for intra-observer agreement was 0.74 [0.63-0.85].
CONCLUSIONS: This score predicts surgical difficulties by adding criteria to bone destruction, in contrast to widely used classifications for revision THA. Moreover, the score is reproducible and predicts the operative time, thus potentially playing an important role during pre-operative planning.
METHODS: IV; prospective observational non-comparative study.