Yun Andrew, Qutami Marilena, Carles Eric
Orthopaedic Surgery, Center for Hip and Knee Replacement, Providence Saint John's Health Center, Santa Monica, USA.
Cureus. 2021 Sep 24;13(9):e18251. doi: 10.7759/cureus.18251. eCollection 2021 Sep.
Background Recurrent hip dislocation despite prior attempts at surgical stabilization is a dreadful and technically challenging complication. A modular dual mobility (MDM) articulation has shown promise in addressing this problem, which might seem intractable. Our purpose was to examine the outcomes of revision total hip arthroplasty (THA) with an MDM placed through a direct anterior (DA) approach when all other conservative and surgical treatments have failed. Methods Fifteen patients revised with an MDM for recurrent instability (RI) between 2012 and 2018 by a single surgeon at a single institution were reviewed retrospectively, with a minimum of two years' follow-up. All patients underwent full acetabular revision with an MDM articulation through a DA approach with intraoperative fluoroscopy. No stems were revised. Dislocations, complications, and clinical outcomes are reported. Results All patients had recurrent posterior instability with a mean number of 4 ± 2 (range: 2 to 8) dislocations prior to MDM revision THA (MDM rTHA). Eight patients had already failed surgical intervention for instability, and seven had failed repeated closed reductions and conservative care. After MDM rTHA, there were no dislocations at a mean follow-up of 4 ± 1 years (range: 2 to 8). Similarly, there were no further revisions or reoperations. Postoperatively, the mean cup inclination improved to 45 ± 2 degrees (range: 41 to 48), and the mean anteversion improved to 20 ± 2 degrees (range: 17 to 23). All cups were well-positioned utilizing fluoroscopic guidance. The mean effective head size increased from 32 mm to 44 mm. The mean hip disability and osteoarthritis disability score (HOOS, Jr) was 73 ± 25% (range: 40 to 100). Conclusion Refractory hip instability in THA may be effectively managed with an MDM articulation, even when prior attempts at surgical stabilization have failed. Intraoperative imaging and a direct anterior approach may aid the challenges of implant positioning and achieving hip stability in a revision setting.
尽管此前曾尝试进行手术稳定治疗，但复发性髋关节脱位仍是一种可怕且在技术上具有挑战性的并发症。模块化双动（MDM）关节在解决这个看似棘手的问题上已显示出前景。我们的目的是研究在所有其他保守和手术治疗均失败后，通过直接前路（DA）入路置入MDM进行翻修全髋关节置换术（THA）的结果。方法：回顾性分析2012年至2018年间由一名外科医生在单一机构为15例复发性不稳定（RI）患者进行MDM翻修手术的病例，随访时间至少为两年。所有患者均通过DA入路在术中透视引导下采用MDM关节进行全髋臼翻修。未翻修股骨柄。报告脱位情况、并发症及临床结果。结果：所有患者在MDM翻修THA（MDM rTHA）之前均有复发性后方不稳定，平均脱位次数为4±2次（范围：2至8次）。8例患者因不稳定已手术治疗失败，7例患者反复闭合复位及保守治疗失败。MDM rTHA术后，平均随访4±1年（范围：2至8年）无脱位发生。同样，也没有进一步的翻修或再次手术。术后，平均髋臼倾斜度改善至45±2度（范围：41至48度），平均前倾角改善至20±2度（范围：17至23度）。所有髋臼在透视引导下位置良好。平均有效股骨头直径从32mm增加到44mm。平均髋关节功能障碍和骨关节炎功能障碍评分（HOOS，Jr）为73±25%（范围：40至100）。结论：即使先前的手术稳定治疗失败，THA中难治性髋关节不稳定也可通过MDM关节有效处理。术中成像和直接前路入路可能有助于在翻修情况下应对植入物定位和实现髋关节稳定的挑战。
