Department of Orthopaedic Surgery, University Paris East, UPEC, Hôpital Henri Mondor, 94010 Creteil, France.
Clin Orthop Relat Res. 2011 Nov;469(11):3148-53. doi: 10.1007/s11999-011-1987-7. Epub 2011 Jul 20.
Although not all elderly patients with femoral neck fractures are candidates for THA, active, mentally competent, independent patients achieve the most durable functional scores with THA compared with hemiarthroplasty. However, a relatively high frequency of early or late dislocation could reduce the potential benefits with THA.
QUESTIONS/PURPOSES: We asked whether the incidence of first-time, recurrent dislocation, and revision differed in patients with hip fractures having THA or hemiarthroplasty.
We retrospectively reviewed 380 patients with hip fractures (380 hips) who underwent THAs between 1995 and 1999, and compared them with 412 patients with hip fractures (412 hips) who underwent hemiarthroplasties between 1990 and 1994. The mean followup was 8 years (range, 1-20 years).
THA had a higher early risk of first-time dislocation and a higher late risk: 19 (4.5%) of the 412 hips treated with hemiarthroplasty had at least one dislocation whereas 30 (8.1%) of the 380 hips treated with THA had at least one dislocation. The cumulative number of dislocations at the most recent followup (first time and recurrent dislocations) was 58 (13%) for the 380 THAs and 22 (5%) for the 412 hemiarthroplasties. At the 10-year followup, eight THAs (2%) had revision (six recurrent dislocations, two loosenings), and 42 hemiarthroplasties (10%) had revision (40 acetabular protrusions, one recurrent dislocation).
The risk of revision for recurrent dislocation increases with THA, but it remains lower than the risk of revision for wear of cartilage and acetabular protrusion in hemiarthroplasty.
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
尽管并非所有股骨颈骨折的老年患者都是全髋关节置换术（THA）的适应证，但与半髋关节置换术相比，积极、精神状态良好且独立的患者采用 THA 可获得更持久的功能评分。然而，较高的早期或晚期脱位发生率可能会降低 THA 的潜在益处。
问题/目的：我们想知道髋部骨折患者行 THA 或半髋关节置换术后首次、复发性脱位和翻修的发生率是否不同。
我们回顾性分析了 1995 年至 1999 年期间行 THA 的 380 例髋部骨折（380 髋）患者，并与 1990 年至 1994 年期间行半髋关节置换术的 412 例髋部骨折（412 髋）患者进行比较。平均随访时间为 8 年（1-20 年）。
THA 的早期首次脱位风险较高，晚期风险也较高：行半髋关节置换术的 412 髋中有 19 髋（4.5%）至少发生过一次脱位，而行 THA 的 380 髋中有 30 髋（8.1%）至少发生过一次脱位。在最近的随访中，380 例 THA 中有 58 例（13%）发生了累计脱位（首次和复发性脱位），412 例半髋关节置换术中有 22 例（5%）发生了累计脱位。在 10 年随访时，8 例 THA（2%）行翻修（6 例为复发性脱位，2 例为松动），42 例半髋关节置换术（10%）行翻修（40 例为髋臼突出，1 例为复发性脱位）。
THA 后复发性脱位的翻修风险增加，但仍低于半髋关节置换术因软骨磨损和髋臼突出而行翻修的风险。
III 级，治疗性研究。有关证据等级的完整描述，请参见作者指南。
