Department of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr 200A, 69118 Heidelberg, Germany.
Swabian Joint Center, Christoph Straße 7, 70178 Stuttgart, Germany.
Medicina (Kaunas). 2021 Nov 1;57(11):1188. doi: 10.3390/medicina57111188.
: Femoral head and liner exchange is an established treatment for polyethylene wear but has had a more limited role in the treatment of other conditions including dislocation, because of concerns about an increased postoperative dislocation rate. Some authors have considered dislocation associated with polyethylene wear to be a contraindication for this procedure. : Our retrospective review evaluated the outcome of head and liner exchange in a small consecutively operated heterogeneous cohort of 20 patients who presented with dislocation unrelated to trauma, component malposition or component loosening. Of this group, 12 had prior primary total hip arthroplasty, and 8 had prior revision total hip arthroplasty, and included 4 patients with prior revision for dislocation. Mean follow-up was 6 ± 3.5 years (range 1-145 months). : Kaplan-Meier analysis revealed a revision-free implant survival from any cause of 80% (confidence interval 95%:64.3-99.6%) at 5 years after head and liner exchange (index surgery). At final follow-up, 83.3% of patients ( = 10) with prior primary total hip arthroplasty and 62.5% of patients ( = 5) with prior revision total hip arthroplasty, had not required subsequent revision for any cause. None (0%) of the primary total hip arthroplasty group and 3 (38%) of the revision arthroplasty group had required revision for further dislocation. Of the eight revision arthroplasty patients, four had a prior revision for dislocation and three of these four patients required further revision for dislocation after index surgery. The fourth patient had no dislocation after index surgery. One additional patient who had prior revision surgery for femoral component fracture suffered dislocation after index surgery, but was successfully treated with closed reduction. : In our study population, femoral head and liner exchange was an effective treatment option for patients with prior primary total hip arthroplasty and also for a highly select group of revision total arthroplasty patients with no prior history of dislocation. Femoral head and liner exchange does not appear to be a viable treatment option for patients who have had revision total arthroplasty after prior dislocations.
股骨头和衬垫置换术是治疗聚乙烯磨损的一种既定方法，但由于担心术后脱位率增加，在治疗其他疾病（包括脱位）方面的作用较为有限。一些作者认为，与聚乙烯磨损相关的脱位是进行这种手术的禁忌症。
我们回顾性评估了在 20 例非创伤性、非组件位置不当或组件松动相关脱位的小连续手术异质队列中，进行股骨头和衬垫置换的结果。该组中有 12 例患者先前接受过初次全髋关节置换术，8 例患者先前接受过全髋关节翻修术，其中 4 例患者先前因脱位而行翻修术。平均随访时间为 6 ± 3.5 年（范围 1-145 个月）。
Kaplan-Meier 分析显示，股骨头和衬垫置换术后 5 年时，任何原因导致的翻修无假体生存率为 80%（置信区间 95%：64.3-99.6%）（索引手术）。在最终随访时，先前接受初次全髋关节置换术的患者中有 83.3%（ = 10）和先前接受全髋关节翻修术的患者中有 62.5%（ = 5）未因任何原因需要进一步翻修。初次全髋关节置换术组中无（0%）和翻修组中 3（38%）患者因进一步脱位而需要翻修。在 8 例翻修关节置换术患者中，有 4 例患者有先前的脱位翻修史，其中 4 例患者在索引手术后需要进一步翻修脱位。第 4 例患者在索引手术后没有脱位。另有 1 例先前因股骨组件骨折接受翻修手术的患者在索引手术后发生脱位，但经闭合复位成功治疗。
在我们的研究人群中，股骨头和衬垫置换术是治疗先前初次全髋关节置换术患者的有效治疗选择，也是一组非常选择的先前无脱位史的翻修全关节置换术患者的有效治疗选择。对于先前有过脱位且接受过翻修全关节置换术的患者，股骨头和衬垫置换术似乎不是一种可行的治疗选择。
