Hartofilakidis George, Karachalios Theofilos
Department of Orthopaedic Surgery, School of Health Studies, University of Thessaly, 22 Papakiziazi Street, Larisa, Greece.
J Bone Joint Surg Am. 2004 Feb;86(2):242-50. doi: 10.2106/00004623-200402000-00005.
It is generally agreed that the clinical and radiographic results of total hip replacement performed for degenerative arthritis secondary to congenital hip disease vary depending on the severity of the anatomical abnormality. In this study, we report the mid-term and long-term clinical and radiographic results of total hip arthroplasty performed for each of the three different types of congenital hip disease.
Between 1976 and 1994, the senior author performed 229 consecutive primary total hip arthroplasties in 168 patients with osteoarthritis secondary to congenital hip disease. Seventy-six hips were dysplastic, sixty-nine had a low dislocation, and eighty-four had a high dislocation. The Charnley low-friction technique was performed in 178 hips, and the so-called hybrid technique was performed in forty-six hips. Cementless arthroplasty was used in only five hips.
After a minimum of seven years of follow-up, the rates of revision of the acetabular components were 15% in the dysplastic hips, 21% in the hips with a low dislocation, and 14% in those with a high dislocation. The rates of revision of the femoral components were 14%, 14%, and 16%, respectively. Survivorship analysis predicted an overall rate of prosthetic survival at fifteen years of 88.8% +/- 4.8% in the dysplastic hips, 73.9% +/- 7.2% in the hips with a low dislocation, and 76.4% +/- 8.1% in those with a high dislocation.
An understanding of the anatomical abnormalities and the use of appropriate techniques and implants make total hip arthroplasty feasible for treatment of the three types of congenital hip disease. In patients with a low dislocation, the major technical problem is reconstruction of the natural acetabulum. In those with a high dislocation, the challenge is to place the acetabular component inside the reconstructed true acetabulum and to use an appropriate femoral implant in the hypoplastic narrow femoral diaphysis.
人们普遍认为，因先天性髋关节疾病继发退行性关节炎而进行的全髋关节置换术的临床和影像学结果会因解剖异常的严重程度而有所不同。在本研究中，我们报告了针对三种不同类型先天性髋关节疾病进行全髋关节置换术的中期和长期临床及影像学结果。
1976年至1994年间，资深作者对168例因先天性髋关节疾病继发骨关节炎的患者连续进行了229例初次全髋关节置换术。76髋为发育不良型，69髋为低位脱位，84髋为高位脱位。178髋采用Charnley低摩擦技术，46髋采用所谓的混合技术。仅5髋采用非骨水泥置换术。
经过至少7年的随访，发育不良型髋关节髋臼部件的翻修率为15%，低位脱位髋关节为21%，高位脱位髋关节为14%。股骨部件的翻修率分别为14%、14%和16%。生存分析预测，发育不良型髋关节假体15年的总体生存率为88.8%±4.8%，低位脱位髋关节为73.9%±7.2%，高位脱位髋关节为76.4%±8.1%。
了解解剖异常情况并使用合适的技术和植入物使全髋关节置换术可用于治疗这三种类型的先天性髋关节疾病。对于低位脱位患者，主要技术问题是重建天然髋臼。对于高位脱位患者，挑战在于将髋臼部件放置在重建的真髋臼内，并在发育不全的狭窄股骨干中使用合适的股骨植入物。
