Lübbeke Anne, Suvà Domizio, Perneger Thomas, Hoffmeyer Pierre
Geneva University Hospitals, Geneva, Switzerland.
Arthritis Rheum. 2009 Apr 15;61(4):552-8. doi: 10.1002/art.24340.
Dislocation is a well-known complication after total hip arthroplasty (THA), and is the second-highest cause of revision surgery. Our objective was to assess the effect of preoperative patient education on the occurrence of hip dislocation within 6 months after primary THA.
Between 1998 and 2007, we conducted a prospective cohort study at the Geneva University Hospital Department of Orthopaedic Surgery, including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head. The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation. The main outcome was the incidence of dislocation within 6 months of surgery.
A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session, whereas 1,641 patients who underwent 1,945 procedures did not. Forty-six dislocations occurred over the study period, 5 (0.8%) in participants and 41 (2.1%) in nonparticipants (absolute risk reduction 1.3%; 95% confidence interval [95% CI] 0.4, 2.3), with the time interval between surgery and dislocation being significantly shorter among participants (0.2 versus 1.2 months). Nonparticipants had a 2.8 times higher risk of dislocation than participants (unadjusted odds ratio [OR] 2.80; 95% CI 1.10, 7.13). Adjustment for age, sex, comorbidities, and prior surgery did not change the results (adjusted OR 2.79; 95% CI 1.09, 7.15).
Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA.
髋关节脱位是全髋关节置换术（THA）后一种常见的并发症，也是翻修手术的第二大原因。我们的目的是评估术前患者教育对初次全髋关节置换术后6个月内髋关节脱位发生率的影响。
1998年至2007年期间，我们在日内瓦大学医院骨科进行了一项前瞻性队列研究，纳入所有采用前外侧经臀肌入路、使用直径28mm股骨头进行的初次全髋关节置换术。术前教育课程于2002年6月开始，内容包括肌肉强化锻炼建议以及术后活动范围限制，以此作为预防脱位的手段。主要结局是术后6个月内脱位的发生率。
2002年6月至2007年6月期间，共有597例接受了656次全髋关节置换术的患者参加了教育课程，而1641例接受了1945次手术的患者未参加。在研究期间共发生46例脱位，参加者中有5例（0.8%），未参加者中有41例（2.1%）（绝对风险降低1.3%；95%置信区间[95%CI]0.4，2.3），参加者手术至脱位的时间间隔明显短于未参加者（0.2个月对1.2个月）。未参加者脱位风险比参加者高2.8倍（未调整优势比[OR]2.80；95%CI1.10，7.13）。对年龄、性别、合并症和既往手术进行调整后，结果未改变（调整后OR2.79；95%CI1.09，7.15）。
我们的研究结果表明，参加术前患者教育课程可能会降低全髋关节置换术后6个月内脱位的风险。
