Chalmers Brian P, Arsoy Diren, Sierra Rafael J, Lewallen David G, Trousdale Robert T
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
J Arthroplasty. 2016 Sep;31(9):1963-9. doi: 10.1016/j.arth.2016.02.021. Epub 2016 Feb 17.
Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort.
Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner. Nineteen were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, redislocation, and revisions.
Mean Harris Hip Scores was 74. Fourteen hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. Eleven hips (19%) redislocated at a mean time to dislocation of 12.2 months; 31% (11 of 36 patients) that underwent modular exchange specifically for instability redislocated. Risk factors for redislocation included number of previous surgeries (P = .013), implantation of a 28 mm femoral head (hazards ratio 12.8), revision indication of instability (P = .04), and modular exchange with constrained liner implantation without acetabular shell revision (P = .01).
Implantation of a focally constrained liner in revision total hip arthroplasty for recurrent instability has a high failure rate, especially with a modular exchange. Although concurrent acetabular revision had a lower redislocation rate, the decision to revise a well-fixed cup should be weighed with potential complications associated with cup revision.
在翻修全髋关节置换术中，解决骨量不足和外展肌张力不足患者的复发性不稳定仍然是一项挑战。一种治疗方法是植入限制性衬垫。本研究的目的是确定高危患者队列中局部限制性衬垫的临床结果、再脱位率和翻修情况。
2008年至2011年期间，58例髋关节植入了局部限制性衬垫。19例与髋臼组件翻修同时进行，39例植入固定良好的髋臼杯。平均年龄为69岁，同侧髋关节既往手术的平均次数为4.2次。平均随访3.5年，我们分析了临床结果、再脱位情况和翻修情况。
Harris髋关节平均评分为74分。在最后随访时，14例髋关节（24%）进行了翻修，3例髋关节（5%）需要再次手术。11例髋关节（19%）发生再脱位，平均脱位时间为12.2个月；专门因不稳定进行模块化置换的患者中有31%（36例中的11例）发生再脱位。再脱位的危险因素包括既往手术次数（P = 0.013）、植入28 mm股骨头（风险比12.8）、不稳定的翻修指征（P = 0.04）以及在未进行髋臼杯翻修的情况下进行模块化置换并植入限制性衬垫（P = 0.01）。
在翻修全髋关节置换术中植入局部限制性衬垫治疗复发性不稳定的失败率较高，尤其是在进行模块化置换时。虽然同时进行髋臼翻修的再脱位率较低，但对于是否翻修固定良好的髋臼杯，应权衡髋臼杯翻修相关的潜在并发症。
