Retrospective Analysis Of Aseptic Loosening And Revision Of Artificial Hip Joint

BackgroundTotal hip arthroplasty can greatly improve the quality of life of patients with end-stage hip disease.It has become one of the most successful and important orthopedic operations in China.Although the technology of hip arthroplasty is more and more mature,in theory,as long as the implant time is long enough,all hip arthroplasty will eventually fail.Failure of the operation can lead to different degrees of pain in the affected hip,limited range of motion of the joint,shortening of the limb and other deformities,resulting in a significant decline in the quality of life of the patients.Revision hip surgery is required to alleviate and treat these complications.According to current studies at home and abroad,aseptic loosening around prosthesis is the primary cause of hip revision.Due to the variety of prosthesis types or fixation methods for the initial replacement,the revision surgical plan is not the same.At present,there is still some controversy about whether to choose the prosthesis with good stability,only to renovate the prosthesis with partial loosening,or to choose the revision surgery of total hip joint.And the choice of different revision plan for aseptic loosening and its influence on the prognosis still need to be further studied.ObjectiveRetrospective analysis was made on the early and middle stage clinical efficacy of revision of aseptic loosening of artificial hip joint,and the differences in perioperative data and prognosis between partial revision and total revision were analyzed and compared.Subjects and methodsFrom May 2011 to may 2019,41 patients with aseptic loosening of prosthesis after hip replacement were selected.The types of primary surgery included 3 cases of artificial femoral head replacement and 38 cases of total hip replacement,including 17 males and 24 females,22 left hips and 19 right hips,aged 19～84 years,average(58.63±15.18)years,average BMI 23.89±3.36.Before operation,the patients with aseptic loosening were screened according to the imaging diagnostic criteria and exclusion criteria of infection.The bone defect types of acetabulum Paprosky and femur Paprosky were evaluated according to the imaging criteria,and the intraoperative treatment methods and operation time were recorded.Harris score was used to evaluate postoperative hip function,Vas score was used to evaluate postoperative pain,and postoperative imaging results and complications were followed up.ResultsThe mean follow-up time of 41 patients was 38.02±23.52(months).The postoperative VAS score(1.00 ± 0.89)was significantly lower than the preoperative VAS score(6.00±1.47),the difference was statistically significant(P<0.001);the postoperative Harris score(79.61±10.35)was significantly higher than the preoperative Harris score(43.42±11.61),and the difference was statistically significant(P<0.001).Postoperative lower extremity difference(8.51±4.47mm)was significantly lower than that before surgery(19.72±11.55mm),and the difference before and after revision was statistically significant(P<0.001).There were 17 cases of partial revision(41.46%)and 24 cases of total revision(58.54%),respectively.There were significant differences in the operation duration(P=0.045)and hemoglobin reduction(P=0.044)between the two types of revision.The Harris score and Vas score before and after surgery were significantly different between the two groups(P<0.001),but the Harris score and Vas score were not significantly different between the two groups.Four patients in this group had postoperative complications(9.76%),including one with sciatic nerve injury(2.44%),one with acetabular prosthesis loosening(2.44%),and two with femoral stem prosthesis sinking(4.88%).No complications such as poor wound healing,postoperative infection and dislocationConclusionThe revision of hip joint can achieve good early and mid-term clinical results in the treatment of aseptic loosening after hip replacement;the partial revision with stable hip prosthesis has shorter operation time and less hemoglobin loss compared with the revision of total hip joint,and there is no statistical difference in the early and mid-term follow-up results;the long-term clinical effect still needs further follow-up analysis.