Center for Joint Preservation and Reconstruction, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA.
Int Orthop. 2011 Jun;35(6):797-802. doi: 10.1007/s00264-010-0962-3. Epub 2010 Feb 20.
Dislocation is one of the most common complications of total hip arthroplasty. The use of constrained liners is an option for the management of chronic hip instability, typically used after other methods have failed. The purposes of this study were to evaluate the overall clinical outcomes and failure rates of a tripolar constrained liner design, to assess the radiographic outcomes of its use, and to examine whether various factors such as abductor mechanism quality and history of previous revision surgeries were associated with an increased risk of failure. Forty-three hips in 39 patients who had a mean follow-up of 51 months (range, 24-110 months) were reviewed. Ninety-one percent of the hips (39 of 43 hips) did not need any revisions over the study period. A new liner was implanted in all four failed hips with concurrent revision of the acetabular cup in three cases. No further dislocations occurred in this group. The mean hip score for surviving hips was 82 points (range, 38-100 points) at final follow-up. Radiographic evaluation revealed stable, well-fixed acetabular components in all surviving hips without progressive radiolucencies. No association was found between abductor muscle quality and the incidence of failure, but patients who experienced a constrained liner failure were more likely to have undergone at least one previous hip revision operation. Tripolar constrained acetabular liners can provide successful outcomes in patients with hip instability, although it is important not to rely on the use of a constrained liner alone in an attempt to compensate for other correctable factors such as component positioning.
脱位是全髋关节置换术最常见的并发症之一。使用约束衬垫是治疗慢性髋关节不稳定的一种选择，通常在其他方法失败后使用。本研究的目的是评估三极约束衬垫设计的总体临床结果和失败率，评估其使用的放射学结果，并检查诸如外展肌机制质量和先前翻修手术史等各种因素是否与失败风险增加相关。对 39 名患者的 43 髋进行了回顾性研究，平均随访时间为 51 个月（范围 24-110 个月）。在研究期间，91%的髋关节（43 髋中的 39 髋）不需要任何翻修。在所有 4 例失败的髋关节中都植入了新的衬垫，并在 3 例中同时翻修髋臼杯。在这组患者中没有再发生脱位。在最终随访时，存活髋关节的平均髋关节评分（范围 38-100 分）为 82 分。放射学评估显示所有存活髋关节的髋臼组件均稳定、固定良好，无进行性透亮线。外展肌质量与失败发生率之间没有关联，但经历约束衬垫失败的患者更有可能至少接受过一次先前的髋关节翻修手术。三极约束髋臼衬垫可在髋关节不稳定的患者中提供成功的结果，但重要的是，不要仅仅依靠使用约束衬垫来试图补偿其他可纠正的因素，如组件位置。
