Clavé Arnaud, Maurer David, Tristan Ludovic, Dubrana Frederic, Lefèvre Christian, Pandit Hemant
The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Headington, Oxford, United Kingdom; LaTIM, Unité INSERM, Hôpital Morvan, Brest, France.
Indiana University School of Medicine, Indianapolis, Indiana.
J Arthroplasty. 2016 Sep;31(9):1970-8. doi: 10.1016/j.arth.2016.02.031. Epub 2016 Feb 24.
Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty. However, no recent studies exist highlighting their effectiveness and/or limitations.
This prospective review included 166 consecutive hip arthroplasties, either primary (27%) or revision (73%), with a unique design of a constrained liner: Lefèvre retentive cup. There were 113 females (69%), and the average age at index surgery was 75.9 years (range, 35-94). The mean follow-up was 6.2 years (range, 0.3-11).
Twenty patients had a reoperation; 10 for infection (4 acute and 6 chronic joint infection) and 10 for cup failure (5 fixation failure, 3 aseptic loosening, and 2 dislocation). Ten-year survivals for cup revision were 89% (CI, 83-94) and 92% (CI, 89-97) for all revision and revision for noninfectious reasons, respectively. When solely evaluating for dislocation, the survival at 10 years was 99% (CI, 97-100). Considering primary and revision cases, 10-year survivals cup revision for aseptic reasons were 92.4% (CI, 84-100) and 92.5% (CI, 87-98), respectively.
The Lefèvre retentive cup demonstrated excellent 10-year's survivorship. With the rate of aseptic loosening around 2% and a dislocation rate around 1%, the cup is as effective as other available devices and is therefore a cost-effective tool to reduce the risk of dislocation in at-risk patients undergoing hip arthroplasty.
限制性衬垫作为挽救手术的一部分，用于为全髋关节置换术后脱位高危患者提供稳定性。然而，近期尚无研究突出其有效性和/或局限性。
这项前瞻性研究纳入了166例连续的髋关节置换术，包括初次置换（27%）或翻修手术（73%），采用了一种独特设计的限制性衬垫：勒费弗尔固定杯。其中女性113例（69%），初次手术时的平均年龄为75.9岁（范围35 - 94岁）。平均随访时间为6.2年（范围0.3 - 11年）。
20例患者进行了再次手术；10例因感染（4例急性和6例慢性关节感染），10例因髋臼杯失败（5例固定失败、3例无菌性松动和2例脱位）。髋臼杯翻修的10年生存率，所有翻修病例为89%（可信区间，83 - 94），非感染原因翻修病例为92%（可信区间，89 - 97）。仅评估脱位情况时，10年生存率为99%（可信区间，97 - 100）。考虑初次和翻修病例，无菌性原因髋臼杯翻修的10年生存率分别为92.4%（可信区间，84 - 100）和92.5%（可信区间，87 - 98）。
勒费弗尔固定杯显示出优异的10年生存率。无菌性松动率约为2%，脱位率约为1%，该髋臼杯与其他现有装置效果相当，因此是降低髋关节置换术高危患者脱位风险的一种经济有效的工具。
