Jurkutat Julia, Zajonz Dirk, Sommer Gerald, Schleifenbaum Stefan, Möbius Robert, Grunert Ronny, Hammer Niels, Prietzel Torsten
Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.
, ZESBO - Zentrum zur Erforschung der Stütz- und BewegungsOrgane, Semmelweisstrasse 14, D-04103, Leipzig, Germany.
BMC Musculoskelet Disord. 2018 Aug 31;19(1):314. doi: 10.1186/s12891-018-2242-0.
Dislocation following total hip arthroplasty has to date not been resolved satisfactorily. Previous work has shown that using a less-invasive adaption of Bauer's lateral transgluteal approach with capsular repair significantly reduces dislocation rates in primary total hip arthroplasty. The aim of this retrospective cohort study was to assess whether this approach also helps to reduce the dislocation rate in revision total hip arthroplasty.
We analyzed revision total hip arthroplasty cases performed between 10/2005 and 12/2013 in our department, classifying capsular repair cases as study group and capsular resection cases as control group. The WOMAC score, the dislocations and the revisions were observed.
A total of 259 cases were included, 100 in the study group and 159 in the control group. In the 12-month follow-up, dislocation rates were significantly lower in the study group (3%, n = 3) compared to the control group (21.4%, n = 34; p = 0.001). Overall follow-up periods were 49 and 79 months, revision frequencies were 10 and 29%, pain improvements were 5.5 compared to 4.4 and the WOMAC global scores averaged 2.0 ± 2.1 and 2.9 ± 2.6 for the study group and the control group, respectively.
The modified, less-invasive, lateral transgluteal approach with capsular repair was accompanied by an 86% reduction in dislocation rates when compared to the conventional technique with capsular resection via the anterolateral Watson-Jones-approach. Capsular repair is possible in about 60% of the revision total hip arthroplasty cases, may be considered as beneficial to avoid dislocation and can therefore be recommended.
全髋关节置换术后脱位问题至今仍未得到令人满意的解决。以往的研究表明，采用对鲍尔氏经臀外侧入路进行微创改良并修复关节囊，可显著降低初次全髋关节置换术的脱位率。本回顾性队列研究的目的是评估该方法是否也有助于降低翻修全髋关节置换术的脱位率。
我们分析了2005年10月至2013年12月在我科进行的翻修全髋关节置换术病例，将修复关节囊的病例归为研究组，切除关节囊的病例归为对照组。观察WOMAC评分、脱位情况和翻修情况。
共纳入259例病例，研究组100例，对照组159例。在12个月的随访中，研究组的脱位率（3%，n = 3）显著低于对照组（21.4%，n = 34；p = 0.001）。总体随访期分别为49个月和79个月，翻修频率分别为10%和29%，疼痛改善程度分别为5.5和4.4，研究组和对照组的WOMAC总体评分分别平均为2.0±2.1和2.9±2.6。
与通过前外侧沃森 - 琼斯入路切除关节囊的传统技术相比，改良的、微创的经臀外侧入路并修复关节囊使脱位率降低了86%。在约60%的翻修全髋关节置换术病例中可以进行关节囊修复，可被认为有利于避免脱位，因此可以推荐使用。
