Mayo Clinic, Rochester, Minnesota.
J Bone Joint Surg Am. 2019 Feb 20;101(4):322-329. doi: 10.2106/JBJS.18.00124.
Two-stage exchange is the most common form of treatment of chronic infection following total hip arthroplasty (THA). We examined the prevalence of, and risk factors associated with, hip instability following 2-stage exchange as well as the fate of reimplanted hip prostheses that dislocated.
Data on 515 2-stage exchange THAs performed between 2000 and 2014 at a single institution were retrospectively reviewed. Risk factors for instability as well as postoperative reoperations and revisions were analyzed. The impact of dislocation on these outcomes was evaluated as well. The mean age at the time of reimplantation was 65 years, and the mean duration of follow-up was 5 years (range, 2 to 15 years).
Dislocation occurred in 52 hips following reimplantation (cumulative probability = 8.9% at 1 year). There was a higher risk of instability in women (hazard ratio [HR] = 1.8, p = 0.038) and in those who had a history of dislocation prior to the 2-stage revision (HR = 5.1, p < 0.001). Younger age, body mass index, number of previous operations, spacer type, surgical approach, use of a constrained liner, femoral head diameter, and persistent or recurrent infection were not found to be significant risk factors. Patients with an absent or ununited greater trochanter or abductor deficiency also had a higher rate of dislocation (HR = 30, p < 0.001), as did patients who underwent reimplantation with a megaprosthesis (HR = 6.0, p < 0.001). The risk of additional reoperations (HR = 121, p < 0.001) and revision surgery (HR = 13, p < 0.001) was significantly higher in patients who experienced a dislocation after the 2-stage exchange.
Dislocation after 2-stage exchange THA continues to be a major concern, with the 1-year cumulative probability found to be 9% in the present study. Female sex, a history of dislocation, an absent or ununited greater trochanter or abductor deficiency, and reimplantation with a megaprosthesis were identified as risk factors for dislocation. There is a remarkable 121-fold increase in the rate of reoperations and a 13-fold increase in the rate of revisions in hips that dislocated after 2-stage exchange THA.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
两阶段置换是治疗全髋关节置换术后慢性感染最常见的方法。我们研究了两阶段置换后髋关节不稳定的发生率和相关危险因素，以及脱位后再植入髋关节假体的命运。
回顾性分析了 2000 年至 2014 年在一家机构进行的 515 例两阶段置换 THA 数据。分析了不稳定的危险因素以及术后再次手术和翻修。还评估了脱位对这些结果的影响。再植入时的平均年龄为 65 岁，平均随访时间为 5 年（范围，2 至 15 年）。
再植入后 52 髋发生脱位（1 年累积概率为 8.9%）。女性（风险比[HR] = 1.8，p = 0.038）和两阶段翻修前有脱位史的患者（HR = 5.1，p < 0.001）不稳定的风险更高。年龄较小、体重指数、既往手术次数、间隔物类型、手术入路、使用约束衬垫、股骨头直径以及持续性或复发性感染均不是显著的危险因素。大转子缺失或不愈合或外展肌缺失的患者脱位率也较高（HR = 30，p < 0.001），使用 megaprosthesis 再植入的患者脱位率也较高（HR = 6.0，p < 0.001）。两阶段置换后发生脱位的患者再次手术（HR = 121，p < 0.001）和翻修手术（HR = 13，p < 0.001）的风险显著增加。
两阶段置换 THA 后脱位仍然是一个主要关注点，本研究 1 年累积概率为 9%。女性、脱位史、大转子缺失或不愈合或外展肌缺失以及 megaprosthesis 再植入被确定为脱位的危险因素。两阶段置换后脱位的髋关节再次手术率显著增加 121 倍，翻修率增加 13 倍。
治疗 IV 级。有关证据水平的完整描述，请参见作者说明。
