Gromov Kirill, Troelsen Anders, Otte Kristian Stahl, Ørsnes Thue, Ladelund Steen, Husted Henrik
Department of Orthopaedic Surgery and.
Acta Orthop. 2015;86(4):463-8. doi: 10.3109/17453674.2015.1028009. Epub 2015 Mar 9.
Patient education and mobilization restrictions are often used in an attempt to reduce the risk of dislocation following primary THA. To date, there have been no studies investigating the safety of removal of mobilization restrictions following THA performed using a posterolateral approach. In this retrospective non-inferiority study, we investigated the rate of early dislocation following primary THA in an unselected patient cohort before and after removal of postoperative mobilization restrictions.
From the Danish National Health Registry, we identified patients with early dislocation in 2 consecutive and unselected cohorts of patients who received primary THA at our institution from 2004 through 2008 (n = 946) and from 2010 through 2014 (n = 1,329). Patients in the first cohort were mobilized with functional restrictions following primary THA whereas patients in the second cohort were allowed unrestricted mobilization. Risk of early dislocation (within 90 days) was compared in the 2 groups and odds ratio (OR)-adjusted for possible confounders-was calculated. Reasons for early dislocation in the 2 groups were identified.
When we adjusted for potential confounders, we found no increased risk of early dislocation within 90 days in patients who were mobilized without restrictions. Risk of dislocation within 90 days was lower (3.4% vs 2.8%), risk of dislocation within 30 days was lower (2.1% vs 2.0%), and risk of multiple dislocations (1.8% vs 1.1%) was lower in patients who were mobilized without restrictions, but not statistically significantly so. Increasing age was an independent risk factor for dislocation.
Removal of mobilization restrictions from the mobilization protocol following primary THA performed with a posterolateral approach did not lead to an increased risk of dislocation within 90 days.
患者教育及活动限制常被用于降低初次全髋关节置换术后脱位风险。迄今为止，尚无研究调查采用后外侧入路进行全髋关节置换术后解除活动限制的安全性。在这项回顾性非劣效性研究中，我们调查了在未选择的患者队列中，初次全髋关节置换术后解除术后活动限制前后早期脱位的发生率。
从丹麦国家卫生注册中心，我们确定了在2004年至2008年（n = 946）以及2010年至2014年（n = 1329）在我们机构接受初次全髋关节置换的2个连续且未选择的患者队列中的早期脱位患者。第一队列中的患者在初次全髋关节置换术后在功能限制下活动，而第二队列中的患者则被允许无限制活动。比较两组90天内早期脱位的风险，并计算调整了可能混杂因素的优势比（OR）。确定两组早期脱位的原因。
当我们对潜在混杂因素进行调整时，我们发现无限制活动的患者在90天内早期脱位风险没有增加。无限制活动的患者90天内脱位风险较低（3.4%对2.8%），30天内脱位风险较低（2.1%对2.0%），多次脱位风险较低（1.8%对1.1%），但差异无统计学意义。年龄增加是脱位的独立危险因素。
采用后外侧入路进行初次全髋关节置换术后，从活动方案中解除活动限制不会导致90天内脱位风险增加。
