Gautam Deepak, Malhotra Rajesh
Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Research performed at All India Institute of Medical Sciences, New Delhi, India.
Arch Bone Jt Surg. 2019 Nov;7(6):506-513.
Optimum component positioning and orientation is required to optimize the functional result during total hip arthroplasty for dysplastic hips.
Sixty-two patients (66 hips) including 33 males and 29 females underwent total hip arthroplasty using modular stem prosthesis at an average age of 40.6 years (range 17 to 49 years). Nineteen hips were classified as Type I, 24 hips as Type II, 13 hips as Type III and 10 hips as Type IV dysplastic hips according to Crowe's classification. Eighteen hips (27.2%) underwent sub trochanteric osteotomy and 23 hips (34.8%) required adductor tenotomy at the time of surgery.
Sixty-one patients (65 hips) were available for the latest follow up. The median follow-up was 57.4 months (range12 to 100 months). The mean Harris Hip Score was 90.6 (range 72 to 96), which was significant improvement from the preoperative Score of 44.8 (range 38 to 62). The clinical outcome was graded as excellent in 39, good in 13, fair in 7 patients and poor in 2 patients respectively. Only one hip (1.5%) had underwent revision surgery for the stem at 18 months following the index surgery. Postoperative dislocation following a fall was seen in one hip of a female patient who was operated on both sides. The radiographs revealed that all the remaining 65 hips had stable femoral component and the osteotomy sites were healed. The Kaplan-Meier survivorship with revision as endpoint (including open reduction for dislocation) was found to be 96.4% at 100 months (95% Confidence Interval; 86.3-99.1).
This study in South-Asian patients using the modular stem strengthened the premise that cementless modular total hip arthroplasty provides a satisfactory outcome in treating secondary osteoarthritis due to dysplastic hips.
在发育性髋关节全髋关节置换术中，需要最佳的组件定位和方向以优化功能结果。
62例患者（66髋），包括33例男性和29例女性，平均年龄40.6岁（范围17至49岁），接受了模块化柄假体全髋关节置换术。根据Crowe分类，19髋为I型，24髋为II型，13髋为III型，10髋为IV型发育性髋关节。18髋（27.2%）在手术时接受了转子下截骨术，23髋（34.8%）需要内收肌切断术。
61例患者（65髋）可进行最新随访。中位随访时间为57.4个月（范围12至100个月）。平均Harris髋关节评分90.6（范围72至96），较术前评分44.8（范围38至62）有显著改善。临床结果分别评为优秀39例，良好13例，一般7例，差2例。仅1髋（1.5%）在初次手术后18个月因柄进行了翻修手术。1例双侧手术的女性患者1髋在跌倒后出现术后脱位。X线片显示，其余65髋的股骨组件均稳定，截骨部位愈合。以翻修为终点（包括脱位的切开复位）的Kaplan-Meier生存率在100个月时为96.4%（95%置信区间；86.3 - 99.1）。
本研究在南亚患者中使用模块化柄强化了以下前提，即非骨水泥模块化全髋关节置换术在治疗发育性髋关节继发骨关节炎方面提供了满意的结果。
