Kiyak Gorkem, Bezer Murat, Ketenci Ismail E, Topkar Osman M
Department of Orthopaedic Surgery, Academic Hospital, Istanbul - Turkey.
Department of Orthopaedic Surgery, Marmara University Faculty of Medicine, Istanbul - Turkey.
Hip Int. 2016 Mar-Apr;26(2):193-8. doi: 10.5301/hipint.5000330. Epub 2016 Feb 25.
Various surgical techniques and outcome results have been reported after primary total hip arthroplasty for the treatment of patients dysplastic hips. Low failure and complication rates have been reported when the acetabular component has been placed in the true acetabulum. The current study reports the results of primary total hip arthroplasty in patients with high and low dislocation for whom the acetabular component was placed in the true acetabulum without femoral or trochanteric osteotomy.
26 primary total hip replacements were performed on 22 patients. The mean duration of follow-up was 8.9 years.There were 4 men and 18 women. 17 hips were classified as type B (low dislocation) and 9 as type C (high dislocation), according to the classification system of Hartofilakidis et al. Acetabular components were placed in the true acetabulum without osteotomy for all patients.
At the time of final follow-up (mean 8.9 years) the average Harris Hip Score was 85 points. Femoral head autograft was used in 9 hips to supplement acetabular coverage. In 8 patient linear calcar fracture. 7 fixed with Dall-Mile cable and 1 fixed with a side plate. On radiologic evaluation, 2 incidents of asymptomatic osteolysis, 1 of acetabular loosening, 1 graft resorption, and 1 impingement (correlated with physical examination) were identified. 2 patients had neuropraxia and were treated medically. There were no early or late infections. Only 1 patient with acetabular loosening required revision surgery.
Although it is surgically difficult to place the acetabular component in the true acetabulum without femoral or trochanteric osteotomy, at the final follow-up we report favourable results. Long-term follow-up is needed to verify our results.
对于发育不良性髋关节患者行初次全髋关节置换术后，已有多种手术技术及结果的报道。当髋臼假体置于真髋臼时，失败率和并发症发生率较低。本研究报告了髋臼假体置于真髋臼且未行股骨或转子截骨术的高低脱位患者初次全髋关节置换术的结果。
对22例患者实施了26例初次全髋关节置换术。平均随访时间为8.9年。男性4例，女性18例。根据Hartofilakidis等人的分类系统，17髋被分类为B型（低位脱位），9髋为C型（高位脱位）。所有患者的髋臼假体均未行截骨术而直接置于真髋臼。
在末次随访时（平均8.9年），平均Harris髋关节评分为85分。9髋使用了股骨头自体骨移植以补充髋臼覆盖。8例患者发生了股骨距线性骨折。7例采用Dall-Mile缆绳固定，1例采用侧板固定。经影像学评估，发现2例无症状性骨溶解、1例髋臼松动、1例移植骨吸收和1例撞击（与体格检查相关）。2例患者出现神经失用症并接受了药物治疗。无早期或晚期感染。仅1例髋臼松动患者需要翻修手术。
尽管在不进行股骨或转子截骨的情况下将髋臼假体置于真髋臼在手术上具有挑战性，但在末次随访时我们报告了良好的结果。需要长期随访以验证我们的结果。
