Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery?

BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate.

Effect of midazolam combined with propofol anesthesia of elderly patients in total hip arthroplasty

Objective:To investigate the effects of midazolam combined with propofol anesthesia on the level of stress, immune function, blood hypercoagulability, and brain injury in elderly patients undergoing total hip arthroplasty.Method: From March 2016 to September 2017, 80 patients were selected to undergo total hip arthroplasty in our hospital, and they were randomly divided into 2 groups, 40 cases in each group, the observation group and the control group were set. The observation group received midazolam and propofol anesthesia, and the control group received propofol anesthesiabefore the anesthesia (T0), 30 min after the surgery (T1), 6 h after the operation (T2), and 4 h after the operation(T3), to compare the stress response, immune function, blood hypercoagulability and brain injury indicators in the two groups.Results:The levels of cortisol (Cor), epinephrine (E), and norepinephrine (NE) remained unchanged in the two groups before anesthesia, the difference was not significant;the Cor, E and NE levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 h after the end of the surgery, the differences were all significant;The levels of CD3+, CD4+, CD8+ and CD4+/CD8+ remained unchanged in the two groups before anesthesia, the difference was not significant, the CD3+, CD4+, CD8+ and CD4+/CD8+ levels in the observation group were higher than those in the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 hours after the end of the surgery;The levels of Fib and D-D remained unchanged in the two groups before anesthesia, the Fib and D-D levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 hours after the end of the surgery,and 12 h after the end of the surgery, differences were all significant;The levels of S-100β and NSE remained unchanged in the two groups before anesthesia, the S-100β and NSE levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 h after the end of the surgery, differences were all significant. Conclusion: Midazolam was combined with propofol anesthesia which has good clinical effects in elderly patients who were undergo total hip arthroplasty. It can effectively relieve stress, regulate immune function, improve blood hypercoagulability, reduce brain injury, and improve sedation after anesthesia.

Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures

Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients

Nomogram to predict postoperative complications in elderly with total hip replacement

BACKGROUND By analyzing the risk factors of postoperative complications in elderly patients with hip replacement,We aimed to develop a nomogram model based on preoperative and intraoperative variables and verified the sensitivity and specificity for risk stratification of postoperative complications in elderly with total hip replacement patients.AIM To develop a nomogram model for risk stratification of postoperative complications in elderly with total hip replacement patients.METHODS A total of 414 elderly patients who underwent surgical treatment for total hip replacement hospitalized at the Affiliated Hospital of Guangdong Medical University from March 1,2017 to August 31,2019 were included into this study.Univariate and multivariate logistic regression were conducted to identify independent risk factors of postoperative complication in the 414 patients.A nomogram was developed by R software and validated to predict the risk of postoperative complications.RESULTS Multivariate logistic regression analysis revealed that age(OR=1.05,95%CI:1.00-1.09),renal failure(OR=0.90,95%CI:0.83-0.97),Type 2 diabetes(OR=1.05,95%CI:1.00-1.09),albumin(ALB)(OR=0.91,95%CI:0.83-0.99)were independent risk factors of postoperative complication in elderly patients with hip replacement(P<0.05).For validation of the nomogram,receive operating characteristic curve revealed that the model predicting postoperative complication in elderly patients with hipreplacement was the area under the curve of 0.8254 (95%CI: 0.78-0.87), the slope of the calibrationplot was close to 1 and the model passed Hosmer-Lemeshow goodness of fit test (χ^(2) = 10.16, P =0.4264), calibration in R E_(max) = 0.176, E_(avg) = 0.027, which all demonstrated that the model was ofgood accuracy.CONCLUSIONThe nomogram predicting postoperative complications in patients with total hip replacementconstructed based on age, type 2 diabetes, renal failure and ALB is of good discrimination andaccuracy, which was of clinical significance.

Participating in health care for total hip replacement patients:an integrative review

In recent years,with the continuous improvement of people's health requirements,the awareness of participating in disease diagnosis and treatment has also been constantly enhanced.Patient’s participation has become a hot issue in medical care policies and research practices.This article intends to review the research background of patient participation and necessity,status,form,significance and existing problems of total hip replacement patients'participation in health care in order to provide reference for the promotion participation in practice.

Patients’ Perspectives on Pre-Operative Education for Total Hip Replacement

The purpose of this qualitative research was to explore subjective experiences related to pre-operative patient education experience with total hip replacement (THR). Semi-structured, in depth interviews were used to collect data. Eleven participants aged 44 to 76 were recruited. Data were analyzed using a constant comparative method. Three categories emerged from interview data. 1) Obedience professions’ knowledge: trust professions’ authority, synchronization with instruction and satisfy information;2) Worries restrict mobility and lose job: post-op activities changes and impact on daily work;3) Information wanted by personal preference: motivation differently. Hopefully insights on pre-operative education to THR patients experience will provide valuable references for application in teaching materials for orthotics’ nurse to improve THR care.

Preliminary Report on Phenom^®Femoral Component in Total Hip Replacement: The Correlation between Outcome Scores in a Cross-Seccional Study

Background: The main purpose of the present study was to assess the short term performance of a cementless femoral stem in total hip replacement. Methods: Cross-sectional observational study of a 48-patient cohort with Phenom? femoral stems implanted between June 1, 2014 and September 1, 2018, to determine clinical performance, stability, and radiographic osseointegration. Patients were followed-up from 13 to 76 months (mean: 44.5 months) and assessed using the Harris Hip Score-HHS, the Hip Disability and Osteoarthritis Outcome Score-HOOS and radiographs. Results: All stems were radiologically stable. Mean Harris Hip Score was 89.8 and the HOOS was 80.4. No statistical differences were observed among patients with different diagnoses. Conclusions: The short-term results revealed satisfactory clinical outcomes and radiological signs of implant stability in all cases. Using two functional scores was useful in detecting biases and a low to moderate agreement was found between the scores.

Lessons learned from study of congenital hip disease in adults

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease(CHD). To achieve better communication among physicians,better treatment planning and evaluation of the results of various treatment options,an agreed terminology is needed to describe the entire pathology. Furthermore,a generally accepted classification of the deformities is necessary. Herein,the authors propose the use of the term "congenital hip disease" and its classification as dysplasia,low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease,which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD,especially those with low and high dislocation,are: Wide exposure,restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

Ultrasound-guided,direct suprainguinal injection for fascia iliaca block for total hip arthroplasty:A retrospective study

BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty.

Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in Hip Arthroplasty at An Advanced Age

combined with sufentanil in elderly patients undergoing hip replacement.Methods:89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control group.The experimental group was anesthetized with light specific gravity ropivacaine combined with sufentanil.The control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse reactions.Results:there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group(P>0.05),and the incidence of adverse reactions between the two groups was low.The sensory block time in the experimental group was shorter than that in the control group(PP>0.05).Conclusion:ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty,and the safety of the anesthesia scheme is higher,which will not lead to serious adverse reactions during operation.Moreover,the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation,and the clinical application value is high.

老年全髋关节置换术病人术后低体温对血液流变学及免疫功能的影响

目的:调查老年全髋关节置换术病人术中体温变化,并探究其对血液流变学与免疫状态的影响。方法:选取2022年4月—2023年4月在江苏省建湖县人民医院行髋关节置换术的病人120例为研究对象,按照是否发生术中低体温分为低温组和正常组,比较两组病人血液流变学与免疫功能指标的变化。结果:120例病人中发生低体温的有39例,发生率为32.5%。低温组病人在手术结束即刻时红细胞比容、红细胞变形指数明显降低,且全血还原黏度、血浆黏度、红细胞聚集指数明显升高,与麻醉前比较差异有统计学意义(P<0.05),全血还原黏度、血浆黏度、红细胞聚集指数和红细胞变形指数与正常组比较差异有统计学意义(P<0.05);术后24 h各指标仍处于升高水平,且全血还原黏度、血浆黏度、红细胞变形指数与正常组比较差异有统计学意义(P<0.05)。在手术开始45 min时、术后24 h时低温组CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)低于对照组,CD_(8)^(+)高于对照组,差异均有统计学意义(P<0.05);在术后48 h时两组CD_(4)^(+)、CD_(8)^(+)及CD_(4)^(+)/CD_(8)^(+)免疫细胞水平比较差异无统计学意义(P>0.05)。结论:老年全髋关节置换术中病人低体温发生率较高,且术中低体温对老年全髋关节置换术病人血液流变学及免疫功能相关指标均具有一定影响,临床中应重视对低体温的监测与管理,降低低体温的发生及危害程度。

全髋关节置换术后患者自我感受负担的影响因素分析

目的:探讨全髋关节置换术(THA)患者自我感受负担(SPB)水平,并分析其相关危险因素。方法:选取收治的76例THA患者,采用自我感受负担量表(SPBS)评估患者术后SPB水平,经线性回归分析THA患者SPB水平的相关危险因素。结果:76例THA患者术后SPBS评分为(32.25±4.16)分,处于中度负担水平;不同学历、家庭月收入、术后并发症、家庭关怀度、社会支持资料的患者SPBS评分比较,差异均具有统计学意义(P<0.05);经线性回归分析结果显示,受教育程度为小学或初中、家庭平均月收入<3000元、术后并发症、家庭关怀度低、社会支持少均为THA患者SPB水平的相关危险因素(P<0.05)。结论:THA患者SPB处于中等水平,主要受患者家庭经济、术后并发症、家庭关怀度、社会支持及受教育程度等因素影响。

全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的效果对比

目的:探讨全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折的效果影响。方法:选取2020年5月—2023年5月陆军第七十一集团军医院就诊的100例老年股骨颈骨折患者作为研究对象,根据手术方式分为照组和观察组,每组各50例。对照组应用半髋关节置换术,观察组应用全髋关节置换术。比较两组髋关节功能手术前后结果、并发症发生率,不同术式下手术及血液流变学指标。结果:术后6个月,两组髋关节Harris评分较术前均有所降低,且观察组上述评分较对照组低,差异有统计学意义(P<0.05)。观察组髋关节功能优良率高于对照组,差异有统计学意义(P<0.05)。观察组髋臼磨损、髋臼增生、患侧髋部肿胀、假体松动代表的并发症发生率均低于对照组,差异有统计学意义(P<0.05)。观察组术中出血量、术后引流量均大于对照组,差异有统计学意义(P<0.05);观察组手术时间、住院时间均长于对照组,差异有统计学意义(P<0.05)。术前及术后0.5个月,两组全血高切黏度(HBV)、全血低切黏度(LBV)、血浆黏度(PV)比较,差异无统计学意义(P>0.05);术后0.5个月,两组HBV、LBV、PV均有所升高,差异有统计学意义(P<0.05)。结论:老年股骨颈骨折施行全髋关节置换术和半髋关节置换术,前者手术效果更佳,对患者术后髋关节功能恢复更有利,能够降低髋臼磨损、增生等并发症发生率,保障髋臼完好性,并改善血液流变学指标。

罗伊适应模式在全髋关节置换术后患者康复中的应用

目的:探讨罗伊适应模式(Roy adaptation model,RAM)在全髋关节置换术后患者康复中的应用。方法:选取该院2020年3月-2023年3月收治的100例全髋关节置换术患者为研究对象,按随机数字表法将其分为对照组与观察组,各50例。对照组采用骨科常规护理,观察组在对照组基础上采用罗伊适应模式的护理。对比2组患者手术后髋关节功能、两周后对功能锻炼知识的了解情况、并发症发生率、SF-36评分。结果:观察组髋关节功能优于对照组,差异有统计学意义(P<0.05)。观察组对关节功能锻炼相应内容了解水平高于对照组,差异有统计学意义(P<0.05)。观察组手术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组SF-36评分高于对照组,差异有统计学意义(P<0.05)。结论:罗伊适应模式在全髋关节置换术后患者痊愈治疗中的效果显著。

心理护理对全髋关节置换术后的老年患者康复效果影响研究

探讨心理护理对老年患者全髋关节置换(total hip arthroplasty,THA)术后的疼痛管理、心理健康以及下肢功能恢复的影响。选取92例单侧THA术后的老年患者为研究对象,将患者随机分为对照组和实验组,每组各46例,两组患者住院期间均实施一般康复护理,并且出院后均实施为期6个月的延续性护理,实验组在此基础上加以心理护理,包括住院期间的心理护理以及出院后为期6个月的延续性心理护理。比较两组患者在疼痛评分、心理健康评估和下肢功能恢复方面的差异。结果显示,实验组患者疼痛评分、心理健康评分和下肢功能恢复情况均显著优于对照组(P<0.05)。研究发现,心理护理对老年患者THA术后的疼痛管理、心理健康以及下肢功能恢复有显著的积极影响,可提高老年患者THA术后的整体康复质量,应得到重视和应用。

老年全髋关节置换术患者康复运动恐惧的现况及其影响因素调查

目的 探究老年全髋关节置换术患者康复运动恐惧的影响因素及护理策略。方法 选取医院2021年4月—2022年3月收治的全髋关节置换术患者176例为调查对象,分析患者临床资料,采用一般资料问卷、中文版恐动症评估简表(TSK)、视觉模拟评分法(VAS)、运动自我效能量表(SEE)、自我感受负担量表(SPBS)对患者进行评价,统计伴有康复运动恐惧的患者例数,通过单因素分析、多因素Logistic回归模型分析,筛选老年全髋关节置换术患者康复运动恐惧的影响因素,并讨论护理策略。结果 经TSK量表评价得到伴有康复运动恐惧(>37分)的患者48例,发生率为27.27%;单因素分析结果显示,老年全髋关节置换术患者康复运动恐惧的影响因素有年龄、文化水平、家庭人均月收入、身体质量指数(BMI)、术后跌倒史、术后康复指导、术后疼痛状况、运动自我效能、自我感受负担(P<0.05);多因素Logistic回归分析显示,老年全髋关节置换术患者康复运动恐惧的影响因素有年龄、初中及以下文化水平、术后跌倒史、术后康复指导、术后疼痛状况、运动自我效能低水平、中重度自我感受负担(P<0.05)。结论 老年全髋关节置换术患者术后康复运动阶段仍伴有不同程度的运动恐惧,年龄大、初中及以下文化水平、有术后跌倒史、无术后康复指导、术后疼痛严重、运动自我效能水平低、中重度自我感受负担的患者发生康复运动恐惧的可能性较大。

直接前入路与后外侧入路人工全髋关节置换术治疗老年股骨颈骨折的早期疗效对比分析

目的探讨在股骨颈骨折老年患者接受人工全髋关节置换术治疗期间,以直接前入路及后外侧入路方式施治的价值。方法回顾性分析2020年1月—2022年1月单县中心医院接受人工全髋关节置换术施治的股骨颈骨折老年患者80例的临床资料,采取数字奇偶法分为对照组与观察组,各40例。对照组采用后外侧入路术式,观察组采用直接前入路术式,对比两组手术相关指标差异。结果观察组手术切口长度短于对照组,出血量、术后引流量均低于对照组,下地时间早于对照组,差异有统计学意义(t=12.824、10.468、4.776、12.099,P<0.05);观察组手术时间为(115.34±23.17)min长于对照组(79.47±20.65)min,差异有统计学意义(t=7.309,P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(χ^(2)=5.165,P<0.05);术后1、3 d,观察组血清学指标CK、CRP、IL-6水平均低于对照组,差异有统计学意义(t=15.828、24.388、12.711、12.880、15.864、23.277,P<0.05);术后1、2个月,观察组髋关节功能评分均高于对照组,差异有统计学意义(t=3.948、4.876,P<0.05)。结论通过以直接前入路及传统后外侧入路方式实施人工全髋关节置换术均可得到一定手术效果,然而应用直接前入路方式所得早期疗效更为显著。

人工股骨头置换术与全髋关节置换术治疗老年移位股骨颈骨折的有效性评价

目的对比人工股骨头置换术、全髋关节置换术两种术法对老年移位股骨颈骨折的治疗有效性及安全性。方法回顾性分析2020年6月—2022年6月期间在江苏省淮安市洪泽区人民医院骨科治疗移位股骨颈骨折的70例老年患者的临床资料,按照手术方法,将20例采取全髋关节置换术的患者设为研究组,将50例采取人工股骨头置换术的患者设为对照组。对比两组手术效果。结果研究组术中失血量比对照组多,手术耗时、下床时间、住院时间比对照组长,差异有统计学意义(P<0.05)。治疗后,研究组髋关节功能评分、术后6个月优良率比对照组高,髋部疼痛评分比对照组低,差异有统计学意义(P<0.05)。研究组并发症发生率(20.00%)比对照组高(2.00%),差异有统计学意义(χ^(2)=4.529,P<0.05)。结论对于老年移位股骨颈骨折,人工股骨头置换术近期疗效好,全髋关节置换术远期疗效好,因此应为患者优选全髋关节置换术。

老年人髋关节置换围手术期并发症及伴发症分析

目的:探讨髋关节置换术对老年人内科伴发症的影响。方法:回顾分析本院1994年1月～2002年7月行髋关节置换术498例病人,分析围手术期65岁以上及65岁以下2组患者内科伴发症变化。结果:术后贫血、肺感染、呼吸衰竭及心力衰竭高龄组发生高于低龄组,高龄组有2例死亡。结论:高龄患者围术期心肺并发症发生率高于低龄组,但绝大多数患者可以安全的接受髋关节置换术。