Emre Anıl ÖZBEK, Hakan KOCAOĞLU, Mustafa Onur KARACA, Abdullah MERTER

Femur Başı Avasküler Nekroz Zemininde Total Kalça Protezi Yapılmış Olgularda Erken Dönem Sonuçlar

Amaç: Femur başı avasküler nekrozu (FBAVN), proksimal femura kan akışının bozulması nedeniyle oluşan bir tür osteonekrozdur. FBAVN hastalarında%30’dan fazla femur başında çökme ve koksartroz görülmektedir ve bu grupta tek kalıcı tedavi kalça artroplastisidir. Yaşı, demografik özellikleri veaktivite durumu ileri yaş kalça artroplasti hastalarından çok farklı olan bu özel grubun operasyon sonrası sonuçları literatürde genellikle ayrıntılıolarak incelenmemiştir. Biz bu çalışma ile merkezimizde FBAVN zemininde gelişen koksartroz için TKP uygulanan hastaların demografisini inceledik.Gereç ve Yöntem: 2015-2018 yılları arasında 4. basamak üniversite ortopedi ve travmatoloji kliniğinde, FBAVN etiyolojisi nedeniyle total kalçaprotezi (TKP) cerrahisi gerçekleştirilmiş hastaların demografik bilgileri, eşlik eden hastalıkları, steroid ilaç kullanım hikayeleri, sigara öyküsü (paket/yıl), cerrahi öncesi direkt grafi ve manyetik rezonans görüntüleme kesitleri, cerrahi sonrası 1. yıla kadar olan komplikasyonları ve direkt grafileriincelenmiştir. Ayrıca hastaların cerrahi öncesi ve sonrası son kontrolde kalça fonksiyonel durumlarını incelemek için Harris kalça skoru (HKS)karşılaştırılmıştır.Bulgular: Yaş ortalaması 42,1±11,6 yıl olan toplam 44 hastanın 34’ü (%77,3) erkek 10’u (%22,7) kadındı. Hastaların 14’ünde (%32) sigara içmeöyküsü mevcut iken 22 (%50) hastada steroid ilaç kullanma hikayesi mevcuttur. Hastaların 17’sinde FBAVN bilateral tespit edilmiş olup dört hastadaher iki kalça da artroz nedeniyle değişik zamanlarda opere edilmiştir. Cerrahi sonrası ortalama takip süresi 19±7 (12-37) ay olarak tespit edilmiştir.Hastaların cerrahi öncesi değerlendirilen HKS ortalama değerleri 59,6 (±7,7) iken ameliyat sonrası son takipte ölçülen HKS skorları 95,8 (±7,1) olaraktespit edilmiştir. Hastaların fonksiyonel kalça skorları anlamlı olarak iyileşmiştir (p=0,003).Sonuç: İleri evre FBAVN varlığında uygun şekilde yapılmış olan TKP güvenli ve başarılı bir yöntemdir. Hastaların ağrıları belirgin olarak azalmagöstermekte ve fonksiyonel sonuçları iyileşme göstermektedir.

Short-term Results of Total Hip Arthroplasty Cases with Osteonecrosis of the Hip

Objectives: Avascular necrosis (AVN) of the femoral head is a type of osteonecrosis caused by impaired blood flow to the proximal femur. Femoral head collapse and coxarthrosis are seen in more than 30% of the patients with AVN of femur, and the only definitive treatment in this group is hip arthroplasty (THA). The post-operative results of this distinct cohort, whose age, demographic characteristics and activity status are very different from advanced age hip arthroplasty patients, have not been generally studied in the literature. With this study, we aimed to examine the demography and early results and complications of patients who underwent THA for coxarthrosis developing on the basis of AVN of the femur in our center. Materials and Methods: Demographic data, comorbidities, corticosteroid and smoking history of patients who underwent THA due to the etiology of AVN in the 4th stage-university orthopedics and traumatology clinic between 2015 and 2018 were evaluated, preoperative X-rays and magnetic resonance images, postoperative 1st year complications were evaluated. In addition, the Harris hip score (HHS) was compared to examine the hip functional status of patients before and after the surgery. Results: The mean age of 44 patients was 42.1±11.6 years, and 34 (77.3%) were male and 10 (22.7%) were female. While 14 (32%) of the patients had a smoking history, 22 (50%) patients had a history of using corticosteroid drugs. In 17 patients, AVN was bilaterally, and in four patients both hips were operated at different times due to arthrosis. The mean follow-up period after the surgery was 19±7 (12-37) months. HHS mean value of the patients evaluated preoperatively was 59.6 (±7.7), while the mean HHS score measured at the last postoperative follow-up was 95.8 (±7.1). Functional hip scores of patients improved significantly (p=0.003). Conclusion: THA, which has been performed in the presence of advanced AVN of the femur, is a safe and successful method. The pain of patients decreases significantly, and their functional results improve.

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