В данной статье представлены результаты частотного анализа сопутствующих заболеваний у пациентов, перенесших ревизионное эндопротезирование тазобедренного сустава, в зависимости от сроков его проведения. Выявлено, что частота ревизионных вмешательству пациентов после эндопротезирования тазобедренного сустава зависит от наличия сопутствующих заболеваний. Проанализированы 667 записей, внесённых в базу данных Новосибирского научно-исследовательского института травматологии и ортопедии им. Я.Л. Цивьяна, за 2013-2015 гг. Относительный риск ранней несостоятельности эндопротеза (до 2 мес. после первичного эндопротезирования) увеличивается в 4,3 раза при наличии сахарного диабета 2-го типа, в 3,7 раза - при хронической анемии, в 3,9 раза - при заболеваниях нервной системы, в 2,9 раза - при заболеваниях вен нижних конечностей, в 2,8 раза - при заболеваниях печени, в 2,0 раза - при избыточной массе тела и ожирении, по сравнению с риском поздней несостоятельности эндопротеза (5 лет и более). При анализе сопутствующей патологии найдены значимые различия частоты хронических заболеваний в зависимости от сроков ревизионного эндопротезирования тазобедренного сустава. В некоторых случаях высокого риска осложнений вследствие коморбидности целесообразнее от операции отказаться вообще.
Background. According to the existing concept of risk factors, the outcome of hip arthroplasty (HA) is affected not only by the quality of the prosthetic work, but also by the presence of one or more concomitant diseases. Purpose of the study - to perform a frequency analysis of co-morbidities in patients who underwent revidion HA, depending on the timing of its conduct. Materials and methods. On the basis of the endoprosthesis clinic at the Novosibirsk Research Institute of Traumatology and Orthopedics, a continuous sample of data was performed from medical records of patients (n = 667), who underwent revision HA in the period of 2013-2015. Primary HA was performed in various medical institutions in Russia and abroad in the period of 1992-2015. The cases of revision Ha were divided according to the terms of their implementation: postoperative (up to 2 months, n = 11), early remote (more than 2 months but less than 5years after HA, n = 371) and late remote (more than 5 years, n = 285). Variable coding and matrix creation, frequency analysis, average and relative risk (RR) calculation were performed. Results. The RR of postoperative and early revision intervention after HA is calculated depending on the presence of concomitant diseases. As a reference group, cases of late revision HA are taken. Calculation of the RR showed that the presence of concomitant diseases increases the risk of failure of the endoprosthesis in the postoperative period (in diabetes mellitus type 2 - 4.3 times, with excessive body weight and obesity - 2.0, with diseases of the nervous system - 3.9, liver - 2.8, veins of the lower extremities - in 2.9 and with chronic anemia - 3.7 times). The risk of undergoing revision HA in the early remote period is 1.7 times higher in the presence of concomitant malignant neoplasm than in the late remote period (p < 0.1). RR decreases with ischemic heart disease, chronic pyelonephritis, cholelithiasis and other pathology of the musculoskeletal system, i.e., revision interventions are performed in these patients much later. Conclusions. When analyzing the concomitant pathology, significant differences in the incidence of chronic diseases were found depending on the timing of the revision HA. Chronic diseases, which are risk factors for early failure of the endoprosthesis, have been identified. In cases when the risk of complications is high due to comorbidity it is more appropriate to refuse from the operation altogether.
The authors declare that there are no conflicts of interest present.