Toomey S D, Hopper R H, McAuley J P, Engh C A
Anderson Orthopaedic Research Institute, Alexandria, VA 22307, USA.
J Bone Joint Surg Am. 2001 Oct;83(10):1529-33. doi: 10.2106/00004623-200110000-00011.
Exchange of modular components is a treatment option for the correction of recurrent dislocation of a total hip replacement. In this study, we reviewed our experience with this technique in order to define patient selection criteria and to report the outcome of treatment.
Of 2935 hips treated with primary porous-coated total hip arthroplasty, fourteen (in fourteen patients) that met certain preoperative and intraoperative criteria were treated with modular component exchange because of recurrent hip instability. The primary arthroplasties in these fourteen patients had been performed through a posterior approach. At the revisions, we removed any sources of osseous or soft-tissue impingement that contributed to dislocation. Acceptable stability at the completion of component exchange was defined as stability in maximum flexion, in full extension with external rotation, and in at least 45 degrees of internal rotation with the hip in 90 degrees of flexion and maximum adduction.
One patient was lost to follow-up. At a mean of 5.8 years (range, 2.8 to 11.8 years) after the revision, ten of the remaining thirteen patients had not had a dislocation. Of the three patients in whom the hip dislocated after the modular component exchange, only one had recurrent dislocation; thus, recurrent dislocation was eliminated in twelve of thirteen patients.
In selected cases, modular component exchange for the treatment of recurrent hip dislocation has a success rate comparable with that of more extensive operations. This method should be considered because it avoids the morbidity associated with revision of well-fixed components. However, to ensure the appropriateness of this surgical option, each patient must be thoroughly evaluated to identify all factors that contribute to instability and adequate intraoperative stability must be achieved.
模块化组件置换是治疗全髋关节置换术后复发性脱位的一种治疗选择。在本研究中，我们回顾了我们在该技术方面的经验，以确定患者选择标准并报告治疗结果。
在2935例接受初次多孔涂层全髋关节置换术治疗的髋关节中，有14例（14名患者）因复发性髋关节不稳定符合某些术前和术中标准，接受了模块化组件置换。这14例患者的初次关节置换均通过后路进行。在翻修手术中，我们去除了所有导致脱位的骨或软组织撞击源。组件置换完成时可接受的稳定性定义为最大屈曲位、伸直位外旋以及髋关节屈曲90°最大内收位至少45°内旋位时的稳定性。
1例患者失访。翻修术后平均5.8年（范围2.8至11.8年），其余13例患者中有10例未发生脱位。在模块化组件置换后髋关节脱位的3例患者中，只有1例出现复发性脱位；因此，13例患者中有12例消除了复发性脱位。
在特定病例中，模块化组件置换治疗复发性髋关节脱位的成功率与更广泛的手术相当。应考虑采用这种方法，因为它避免了与固定良好的组件翻修相关的并发症。然而，为确保这种手术选择的适宜性，必须对每位患者进行全面评估，以识别所有导致不稳定的因素，并且必须在术中获得足够的稳定性。
