Kalça artroplastisi uygulanan hastalarda koksartroz etiyolojisi

Abstract

Amaç: Total kalça protezi uygulanan hastalarda koksartroz etiyolojisini incelemeyi amaçladık. Çalışma planı: 2001-2012 yılları arasında İstanbul’da iki ayrı klinikte total kalça protezi uygulanmış 886 hastanın 965 kalçasının kayıtları incelendi. Her hastanın ameliyat öncesi ve sonrası grafileri ve yaş, cinsiyet, taraf bilgileri değerlendirildi. Bulgular 2 ortopedi uzmanı tarafından bağımsız olarak değerlendirilerek muhtemel etiyolojik neden belirlendi. Bulgular: Hastaların 684’ü kadın, 202’si erkek idi. Yaş ortalaması kadınlarda 62.7±14.3 (dağılım: 16-91), erkeklerde ise 58.8±17.1 (dağılım: 25-91) olarak bulundu. Hastaların %52.1’inin sağ, %39’unun sol ve %8.9’unun her iki kalçası opere edilmişti. Kadın hastaların %36.2’sinde primer koksartroz varken, etiyoloji hastaların %43.5’inde gelişimsel kalça displazisine (GKD), %10’unda avasküler nekroza (AVN), %7’sinde romatizmal hastalıklara, %5’inde femur başı epifiz kaymasına (FBEK), %3.9’unda posttravmatik koksartroza (PTK), %1.9’inde patolojik koksartroza ve %1.7’sinde Perthes sekeline bağlıydı. Erkekler hastaların %24.4’ünde primer koksartroz varken, etiyoloji hastaların %21’inde AVN’ye, %17.6’sında GKD’ye, %16.8’inde PTK’ye, %10.9’unda romatizmal hastalıklara, %4.2’sinde Perthes sekeline, %2.5’inde FBEK’ye ve %2.5’inde patolojik koksartroza bağlandı. Tüm popülasyonda ise en sık etiyolojik faktör %37.1 ile GKD olarak bulundu. Çıkarımlar: İncelenen hasta popülasyonunun heterojenitesine rağmen çalışmamız ülkemizdeki koksartroz etiyolojisi dağılımı hakkında genel bir bilgi vermektedir. Halen displaziye bağlı koksartroz en sık etiyolojik faktör olarak görülmektedir.

Keywords

• Displazi; gelişimsel kalça displazisi; koksartroz; osteoartrit; total kalça protezi.

Etiology of coxarthrosis in patients with total hip replacement

Abstract

Objective: We aimed to find out the distribution of etiological factors in patients who had total hip replacement for coxarthrosis.
Methods: The medical records of the 965 hips of 886 patients operated with total hip replacement between 2001 and 2012 in two separate arthroplasty clinics were analyzed by two separate senior surgeons. Each patient’s pre- and postoperative X-rays and demographic data such as gender, age, side and probable etiologic factors were noted.
Results: Six hundred and eighty-four patients were women and 202 were men. The mean age were 62.7±14.3 (range: 16 to 91) in women, 58.8±17.1 (range: 25 to 91) in men. 52.1% of the surgeries were performed on the right side, 39% on the left, and 8.9% bilaterally. In women 36.2% of the cases were primary coxarthrosis, while the etiology was developmental dysplasia of the hip (DDH) in 43.5% of the cases, avascular necrosis in 10%, romatoid diseases in 7%, slipped capital femoral epiphysis in 5%, posttraumatic coxarthrosis in 3.9%, pathologic coxarthrosis in 1.9%, and Perthes sequel in 1.7%. In men, 24.4% of the cases were primary coxarthrosis, while the etiology was avascular necrosis in 21% of the cases, DDH in 17.6%, posttraumatic coxarthrosis in 16.8%, romatoid diseases in 10.9%, Perthes sequel in 4.2%, slipped capital femoral epiphysis in 2.5%, and pathologic coxarthrosis in 2.5%. The most common etiologic factor was DDH with a rate of 37.1%.
Conclusion: Despite the heterogeneity of our study population, our results may reflect the distribution of coxarthrosis etiologies in Turkey. Developmental dysplasia of the hip appears to be the most frequent cause of coxarthrosis among the patients undergoing total hip replacement.

Keywords

• Coxarthrosis
• developmental dysplasia of the hip
• dysplasia
• osteoarthritis
• total hip replacement

References

1. Franklin J, Ingvarsson T, Englund M, Ingimarsson O, Robertsson O, Lohmander LS. Natural history of radiographic hip osteoarthritis: a retrospective cohort study with 11-28 years of followup. Arthritis Care Res (Hoboken) 2011;63:689
2. Yochum TR, Rowe LJ. Essentials of skeletal radiology. 2nd ed. Baltimore: Williams&Wilkins; 1996.
3. Karachalios T, Karantanas AH, Malizos K. Hip osteoarthritis: what the radiologist wants to know. Eur J Radiol 2007; 63:36-48.
4. Typpo T. Osteoarthritis of the hip. Radiologic findings and etiology. Ann Chir Gynaecol Suppl 1985;201:1-38.
5. Padilla Esteban ML, Nogales Espert A, García-Siso Pardo JM, Curto de la Mano A. Incidence of congenital hip dislocation in 40,243 live births (I). [Article in Spanish] An Esp Pediatr 1990;33:535-8.
6. Treiber M, Tomazic T, Tekauc-Golob A, Zolger J, Korpar B, Burja S, et al. Ultrasound screening for developmental dysplasia of the hip in the newborn: a population-based study in the Maribor region, 1997-2005. Wien Klin Wochenschr 2008; 120:31-6.
7. Songür M, Akel I, Karahan S, Kuzgun U, Tümer Y. Prevalence of untreated hip dislocation in Turkish children aged 6 months to 14 years. Acta Orthop Traumatol Turc 2011; 45:215-20.
8. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am 1979;61:15-23.

9. Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 2008;466:264-72.
10. Ipach I, Mittag F, Syha R, Kunze B, Wolf P, Kluba T. Indications for total hip arthroplasty in young adults - idiopathic osteoarthritis seems to be overestimated. Rofo 2012; 184:239-47.
11. Liu YE, Hu S, Chan SP, Sathappan SS. The epidemiology and surgical outcomes of patients undergoing primary total hip replacement: an Asian perspective. Singapore Med J 2009; 50:15Chu XB, Tong PJ, Zhang JH. Total hip arthroplasty for the post-traumatic osteoarthritis after open reduction and internal fixation of acetabular fracture. [Article in Chinese] Zhonghua Wai Ke Za Zhi 2010;48:1097-100.
12. Li JW, Qiu GX, Weng XS, Jin J, Lin J, Zhao H. Total hip arthroplasty for patients with osteoarthritis secondary to hip developmental dysplasia. [Article in Chinese] Zhonghua Wai Ke Za Zhi 2005;43:255-8.
13. Froberg L, Christensen F, Pedersen NW, Overgaard S. The need for total hip arthroplasty in Perthes disease: a long-term study. Clin Orthop Relat Res 2011;469:1134-40.
14. Goker B, Sancak A, Haznedaroglu S. Radiographic hip osteoarthritis and acetabular dysplasia in Turkish men and women. Rheumatol Int 2005;25:419-22.
15. Okano K, Takaki M, Okazaki N, Shindo H. Bilateral incidence and severity of acetabular dysplasia of the hip. J Orthop Sci 2008;13:401-4.