Janz Viktor, Wassilew Georgi I, Putzier Michael, Kath Geraldine, Perka Carsten F
Department of Orthopaedic, Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany.
Arch Med Sci. 2021 Jan 8;18(1):133-140. doi: 10.5114/aoms/92214. eCollection 2022.
After a first-time total hip arthroplasty (THA) dislocation, a closed reduction followed by partial immobilization in an abduction brace is the recommended therapy. Despite modern abduction braces the success rate of conservative therapy is limited and evidence is scarce. The aim of this study was to identify risk factors for failure of conservative treatment after THA dislocation.
Eighty-seven patients, with conservative treatment of a first-time dislocation of a primary or revision THA, were included in this retrospective cohort study. Success was defined as a stable THA for a minimum of 6 months. Re-dislocation, open reduction or revision was defined as failure. The following risk factors were analyzed: gender, age, body mass index (BMI), ASA (American Society of Anesthesiologists) score, time of dislocation, head size, cup orientation, leg length, center of rotation and offset.
Sixty-seven percent of all patients experienced a re-dislocation, despite standardized conservative therapy. A BMI ≥ 25 kg/m, early THA dislocation, and low cup anteversion were associated with a statistically significantly higher risk for re-dislocation. None of the other risk-factors achieved statistical significance. A multifactorial risk-factor analysis was performed to assess whether a cup position outside of Lewinnek's safe zone in combination with gender, BMI and time to dislocation showed statistical significance for re-dislocation. Both BMI ≥ 25 kg/m and early dislocation showed a statistically higher failure rate. Cup position and gender were not significant.
BMI ≥ 25 kg/m, early THA dislocation and low cup anteversion were identified as significant risk factors for failure of conservative treatment with an abduction brace for first-time THA dislocation.
初次全髋关节置换术（THA）脱位后，推荐的治疗方法是先行闭合复位，然后使用外展支具进行部分固定。尽管有现代的外展支具，但保守治疗的成功率有限且证据不足。本研究的目的是确定THA脱位后保守治疗失败的危险因素。
本回顾性队列研究纳入了87例初次或翻修THA脱位后接受保守治疗的患者。成功定义为THA稳定至少6个月。再次脱位、切开复位或翻修定义为失败。分析了以下危险因素：性别、年龄、体重指数（BMI）、美国麻醉医师协会（ASA）评分、脱位时间、股骨头大小、髋臼杯方向、腿长、旋转中心和偏心距。
尽管采用了标准化的保守治疗，仍有67%的患者再次脱位。BMI≥25kg/m²、早期THA脱位和髋臼杯前倾角低与再次脱位的统计学显著高风险相关。其他危险因素均未达到统计学显著性。进行多因素危险因素分析，以评估髋臼杯位置超出Lewinnek安全区并结合性别、BMI和脱位时间对再次脱位是否具有统计学显著性。BMI≥25kg/m²和早期脱位均显示出统计学上较高的失败率。髋臼杯位置和性别不显著。
BMI≥25kg/m²、早期THA脱位和髋臼杯前倾角低被确定为初次THA脱位使用外展支具保守治疗失败的显著危险因素。
