Dargel Jens, Oppermann Johannes, Brüggemann Gert-Peter, Eysel Peer
Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Institute of Biomechanics and Orthopedics, German Sport University Cologne.
Dtsch Arztebl Int. 2014 Dec 22;111(51-52):884-90. doi: 10.3238/arztebl.2014.0884.
Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total hip endoprosthesis, an event that arises in about 2% of patients within 1 year of the operation. Physicians should be aware of how this problem can be prevented and, if necessary, treated, so that the degree of trauma due to hip dislocation after hip replacement surgery can be kept to a minimum.
The authors searched Medline selectively for pertinent publications and analyzed the annual reports of international endoprosthesis registries.
The rate of dislocation of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28%, depending on the patient population, the follow-up interval, and the type of prosthesis. Patient-specific risk factors for displacement of a hip endoprosthesis include advanced age, accompanying neurologic disease, and impaired compliance. Patients should scrupulously avoid hip movements such as bending far forward from a standing position, or internal rotation of the flexed hip. Operation-specific risk factors include suboptimal implant position, insufficient soft-tissue tension, and inadequate experience of the surgeon. Conservative treatment is justified the first time dislocation occurs without any identifiable cause. If a mechanical cause of instability is found, then operative revision should be performed as recommended in a standardized treatment algorithm, because, otherwise, dislocation is likely to recur.
The dislocation of a total hip endoprosthesis is an emotionally traumatizing event that should be prevented if possible. Preoperative risk assessment should be performed and the operation should be performed with optimal technique, including the best possible physical configuration of implant components, soft-tissue balance, and an adequately experienced orthopedic surgeon.
髋关节置换术是肌肉骨骼系统中较为成功的手术之一，但也可能出现严重并发症。常见的一种并发症是全髋关节假体脱位，约2%的患者在术后1年内会发生这种情况。医生应了解如何预防该问题，以及在必要时如何进行治疗，以便将髋关节置换术后因髋关节脱位导致的创伤程度降至最低。
作者有选择地在Medline上搜索相关出版物，并分析国际假体注册机构的年度报告。
初次髋关节置换术的脱位率每年在0.2%至10%之间，而已经进行过手术翻修的人工髋关节脱位率可能高达28%，这取决于患者群体、随访间隔和假体类型。髋关节假体移位的特定患者风险因素包括高龄、伴有神经系统疾病和依从性受损。患者应严格避免髋关节运动，如从站立位向前过度弯腰或屈曲髋关节的内旋。特定手术风险因素包括植入物位置欠佳、软组织张力不足和外科医生经验不足。首次发生脱位且无任何可识别原因时，保守治疗是合理的。如果发现不稳定的机械原因，则应按照标准化治疗算法的建议进行手术翻修，否则脱位很可能复发。
全髋关节假体脱位是一个令人情绪创伤的事件，应尽可能预防。应进行术前风险评估，手术应采用最佳技术进行，包括植入部件的最佳物理配置、软组织平衡以及经验丰富的骨科医生。
