The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
Clin Orthop Relat Res. 2011 Feb;469(2):417-22. doi: 10.1007/s11999-010-1668-y.
In 2005, we reported removal of functional restriction after primary THA performed through the anterolateral approach did not increase the incidence of dislocation.
QUESTIONS/PURPOSES: To develop a current practice guideline, we evaluated the incidence of early dislocation after primary THA after implementation of a no-restriction protocol.
Between January 2005 and December 2007, 2532 patients (2764 hips; 1541 women, 1223 men; mean age, 63.2 years [28-98 years]) underwent primary THA at our institution. Bilateral THA was performed in 232 patients (464 hips). The direct anterior or anterolateral approach was used in all patients. Femoral head size was 28, 32, or 36 mm. Patients were given no traditional functional restrictions postoperatively, such as use of elevated seats, abduction pillows, and restriction from driving. All patients received standard care at the judgment of the attending surgeon. One hundred forty-six patients missed followup appointments despite efforts to be contacted by telephone. The remaining 2386 of 2532 patients (94%) had a minimum followup of 6 months (mean, 14.2 months; range, 6-34 months).
Four known dislocations occurred in the followed cohort of 2386 patients with 2612 hips (0.15%) at a mean of 5 days (3-12 days) postoperatively, none related to high-impact trauma. One dislocation occurred in a patient with a history of developmental dysplasia of the hip, two dislocations occurred while at the toilet (one with a previous hip fracture treated with a modular system), and one dislocation was idiopathic.
We confirmed a low incidence of dislocation after primary THA in the absence of early postoperative restrictions. We conclude a no-restriction protocol does not increase the incidence of early dislocation after primary THA.
Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
2005 年，我们报告称，通过前外侧入路初次全髋关节置换术（THA）后去除功能限制并不会增加脱位的发生率。
问题/目的：为制定当前的实践指南，我们评估了在实施无限制方案后初次 THA 后早期脱位的发生率。
在 2005 年 1 月至 2007 年 12 月期间，我院共对 2532 例患者（2764 髋；1541 例女性，1223 例男性；平均年龄 63.2 岁[28-98 岁]）进行了初次 THA。232 例患者接受了双侧 THA（464 髋）。所有患者均采用直接前侧或前外侧入路。股骨头大小为 28、32 或 36mm。术后患者未采用传统的功能限制，如使用高座椅、外展枕和限制开车。所有患者均根据主治医生的判断接受标准治疗。尽管我们通过电话联系，但仍有 146 例患者未按预约前来就诊。在随访的 2532 例患者中，有 2386 例（94%）至少随访了 6 个月（平均 14.2 个月；范围，6-34 个月）。
在随访的 2386 例患者中，有 2612 髋（0.15%）在术后平均 5 天（3-12 天）时发生了 4 例已知的脱位，均与高能量创伤无关。其中 1 例脱位发生在髋关节发育不良病史的患者，2 例发生在厕所时（其中 1 例为既往用模块化系统治疗的髋部骨折），1 例为特发性脱位。
我们证实了在没有早期术后限制的情况下，初次 THA 后脱位发生率较低。我们得出结论，无限制方案不会增加初次 THA 后早期脱位的发生率。
II 级，治疗性研究。请参阅作者指南，以获取完整的证据等级描述。
