Kenanidis Eustathios, Kakoulidis Panagiotis, Anagnostis Panagiotis, Potoupnis Michael, Tsiridis Eleftherios
Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece.
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.
Hip Int. 2023 Jan;33(1):53-61. doi: 10.1177/11207000211010712. Epub 2021 Apr 26.
The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients' scores were assessed. Surgical tips to enhance outcomes were reviewed.
45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient's age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years.
There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1-84.5) and 80.5 months for dislocation (95% CI, 75.8-85.2). The mean postoperative functional scores were significantly improved ( < 0.001) at the latest follow-up.
CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs' offset relative to stem-neck impingement are necessary to maximise outcomes.
全髋关节置换术（THA）中限制性衬垫（CLs）的效果尚无定论。我们评估了由单一外科医生进行初次或翻修THA的一系列连续高风险脱位患者中CLs的中期性能。评估了其生存率、脱位率、并发症及患者功能评分。回顾了提高手术效果的技巧。
从塞萨洛尼基关节成形术登记处对2010年至2019年间接受Trident Tripolar CL的45例患者进行回顾性评估。其中有17例初次THA和28例翻修THA。使用CL的主要指征为严重外展肌功能不全或合并症，这增加了初次手术时的脱位风险，以及翻修THA时的复发性脱位或外展肌功能不全。患者平均年龄为68.5（±14.5）岁，平均随访时间为3.81（±1.66）年。
翻修组有2例脱位和1例深部感染。无论何种原因，6年累积生存率为93.3%，初次THA为100%，翻修THA为89.3%。CLs因任何原因的平均总生存率为76.3个月（95%可信区间，68.1 - 84.5），因脱位为80.5个月（95%可信区间，75.8 - 85.2）。在最近一次随访时，术后平均功能评分有显著改善（<0.001）。
在中期随访中，CLs可为初次和翻修THA后脱位风险高的特定低需求患者提供髋关节稳定性和持久固定。为使手术效果最大化，必须仔细选择患者，并采用针对中性衬垫位置且考虑CLs相对于柄 - 颈撞击的高偏移量的精细手术技术。
