Université de Lille-2, Hauts-de-France, 59000 Lille, France; Service d'orthopédie, hôpital Salengro, CHU de Lille, place de Verdun, 59000 Lille, France.
Université de Lille-2, Hauts-de-France, 59000 Lille, France; Service d'orthopédie B, hôpital Jean-Bernard, avenue Desandrouin, 59300 Valenciennes, France.
Orthop Traumatol Surg Res. 2018 May;104(3):325-331. doi: 10.1016/j.otsr.2017.10.017. Epub 2017 Dec 22.
Dislocation rates in posterior total hip arthroplasty (THA) range between 2% and 5%, but long-term course (recurrence of dislocation or revision surgery) is not known, most series having short follow-up or small populations. We therefore conducted a retrospective study on a large series, to determine long-term rates of recurrence and surgical revision and recurrence risk factors.
Long-term follow-up of a large cohort of THA dislocations enables recurrence rate and factors to be determined.
Five hundred and nine cases of THA dislocation were admitted to our center between 1994 and 2008. A hundred and twenty seven incomplete files and 150 patients who had received their THA elsewhere were excluded, leaving 232 patients: 150 female, 82 male. Mean age at THA (163 primary, 69 revision) was 63 years (range, 15-90 years), and 65 years (range 20-90 years) at first dislocation, with a mean interval to dislocation of 25 months. Minimum follow-up was 8 years up to 2016, or 1 year taking account of deaths (111 deaths). There were 46 anterior, 185 posterior and 1 multidirectional dislocations. The following potential recurrence factors were assessed: gander, age, body-mass index (BMI), etiology, surgical history, bearing diameter and type, component fixation means, dislocation direction, and time to dislocation.
A hundred and thirty three of the 232 patients (57%) showed at least 1 recurrence, at a mean 38 months (range, 0.5-252 months); 78 experienced a second and 32 a third recurrence. Ninety-nine (43%) had only 1 dislocation, without recurrence, but 17 of these (17%) underwent reoperation for other causes. The reoperation rate was 17/232 (7%) excluding recurrent instability, and 84/232 (36%) for instability. Fourty-eight months after the first dislocation, 84/133 cases of recurrence (63%) had been reoperated on: 16 complete replacements, 18 bearing replacements, 42 dual mobility cups, one large diameter cup, seven Lefèvre retentive cups. The rate of revision surgery for instability was high, at 84/232 (36%), and higher again in relation to recurrence (84/133: 63%). Only posterior dislocation emerged as a factor for recurrence (HR=1.774, 95% CI [1.020-3.083]), the other tested factors showing no correlation.14 of the 84 revision surgeries for instability (16.6%) were followed by recurrence, without identifiable risk factors.
CONCLUSION/DISCUSSION: The recurrence rate was 57%, with posterior dislocation as the only risk factor. The rate of revision surgery for recurrence was 84/232 (36%), with 14/84 revision procedures (16.6%) followed by further recurrence.
IV, retrospective, without control group.
后路全髋关节置换术后（THA）脱位率为 2%-5%，但长期病程（脱位复发或翻修手术）尚不清楚，大多数研究随访时间短或患者数量少。因此，我们对大量患者进行了回顾性研究，以确定脱位的长期复发率和手术翻修率及复发危险因素。
对大量 THA 脱位患者进行长期随访，可确定复发率和危险因素。
1994 年至 2008 年期间，我们中心收治了 509 例 THA 脱位患者。排除了 127 例不完整的病历和 150 例在其他地方接受 THA 的患者，最终纳入 232 例患者：女性 150 例，男性 82 例。初次 THA 时（163 例初次置换，69 例翻修）的平均年龄为 63 岁（范围 15-90 岁），首次脱位时的平均年龄为 65 岁（范围 20-90 岁），脱位的平均间隔时间为 25 个月。至 2016 年随访至少 8 年，或考虑死亡（111 例死亡）的 1 年。其中 46 例为前脱位，185 例为后脱位，1 例为多方向脱位。评估了以下可能的复发因素：性别、年龄、体重指数（BMI）、病因、手术史、承载体直径和类型、假体固定方式、脱位方向和脱位时间。
232 例患者中 133 例（57%）至少出现 1 次复发，平均复发时间为 38 个月（范围 0.5-252 个月）；78 例患者发生第 2 次脱位，32 例发生第 3 次脱位。99 例（43%）仅有 1 次脱位而无复发，但其中 17 例（17%）因其他原因再次手术。翻修率为 17/232（7%）不包括不稳定复发，84/232（36%）为不稳定复发。首次脱位后 48 个月，133 例复发病例中有 84 例（63%）再次手术：16 例全髋关节置换术，18 例髋关节置换术，42 例双动杯，1 例大直径杯，7 例 Lefèvre 保持杯。不稳定的翻修手术率较高，为 84/232（36%），与复发率（84/133：63%）相比更高。只有后脱位是复发的危险因素（HR=1.774，95%CI[1.020-3.083]），其他测试因素无相关性。84 例不稳定翻修手术中有 14 例（16.6%）术后再次复发，无明确的危险因素。
结论/讨论：复发率为 57%，后脱位是唯一的危险因素。复发的翻修手术率为 84/232（36%），其中 14/84 例（16.6%）的翻修手术后继发复发。
IV，回顾性，无对照组。
