Marcelino Gomes Luiz S, do Carmo Wellington, de Souza Wender
Department of Orthopedics and Rehabilitation, Santa Casa de Batatais, São Paulo, Brazil.
Orthopedics. 2011 Jun 14;34(6):203. doi: 10.3928/01477447-20110427-29.
Bipolar hemiarthroplasty remains a treatment option for displaced femoral neck fractures in elderly patients without pre-existing hip disease. Implant-related complications associated with this procedure include acetabular erosion, dislocation, disassembly of the modular components, polyethylene debris-induced osteolysis, metallosis from outer cup impingement, and femoral component loosening. This article presents a case of a patient in whom the polished collarless tapered femoral stem dislodged out of the cement mantle during traumatic bipolar hemiarthroplasty dislocation, 28 days after the index procedure. This complication, associated with bipolar hemiarthroplasty dislocation, was adequately managed by driving the stem back to the original cement mantle, followed by reduction of bipolar component dislocation and placing bone cement over the shoulder of the femoral stem to prevent a new dislodgement episode. Although rare, dislodgement of cemented polished collarless tapered stems from the cement mantle has been recently reported either during dislocation or, more frequently, as a complication of reduction of a dislocated total hip arthroplasty. However, its occurrence in association with bipolar hemiarthroplasty dislocation was not found to have been reported in the literature. The occurrence of femoral stem dislodgement during bipolar hemiarthroplasty dislocation should be considered as a possible complication of such a procedure and may be prevented by routinely placing bone cement over the shoulder of the femoral implant.
双极半髋关节置换术仍然是治疗无髋关节疾病的老年患者股骨颈移位骨折的一种选择。与该手术相关的植入物相关并发症包括髋臼侵蚀、脱位、模块化部件的分解、聚乙烯碎屑引起的骨溶解、外杯撞击导致的金属沉着症以及股骨部件松动。本文介绍了一例患者，在初次手术后28天的创伤性双极半髋关节置换术脱位过程中，无领抛光锥形股骨柄从骨水泥壳中脱出。这种与双极半髋关节置换术脱位相关的并发症，通过将股骨柄推回原来的骨水泥壳，随后复位双极部件脱位，并在股骨柄肩部上方放置骨水泥以防止再次脱位，得到了妥善处理。尽管罕见，但最近有报道称，在脱位过程中，或者更常见的是，作为脱位的全髋关节置换术复位的并发症，有领抛光锥形股骨柄会从骨水泥壳中脱出。然而，尚未发现其与双极半髋关节置换术脱位相关的情况在文献中有报道。双极半髋关节置换术脱位期间股骨柄脱出应被视为该手术可能的并发症，并且可以通过常规在股骨植入物肩部上方放置骨水泥来预防。
