From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont.
Can J Surg. 2022 Feb 18;65(1):E128-E134. doi: 10.1503/cjs.021220. Print 2022 Jan-Feb.
The dislocated hip hemiarthroplasty (HA) remains a difficult condition to treat owing to frailty, comorbidity, poor quality of bone and soft tissues. We aimed to identify parameters contributing to instability following hip HA and describe the operative management and patient outcomes.
We retrospectively reviewed consecutive cases of all patients with hip fracture treated between 2004 and 2019 at a single tertiary care institution. We propensity matched patients with and without hip dislocations on a 1:2 basis for age, sex, and approach. We reviewed risk factors for HA dislocation, performed radiographic measurements, and recorded management of dislocation and further complications.
Of the 1472 patients treated with HA, we included 18 patients (1.2%) who sustained at least 1 dislocation in our analysis. Of the dislocations identified, 13 and 17 occurred within 1 and 3 months postoperative, respectively. The presence of dementia and low preoperative lateral centre-edge angle were associated with increased risk of dislocation. The 2-year mortality rate was significantly higher in the dislocation group ( = 9) than the control group ( = 2) ( = 0.0003). Nine of 18 (50%) patients were treated with an initial closed reduction; 5 of these 9 (56%) sustained further dislocations and required additional treatment. Six of 18 cases were treated with a total hip arthroplasty after their first dislocation. By final follow-up, 2 of 18 patients had Girdlestone procedures.
This study highlights patient factors associated with increased dislocation risk following hip HA. A thorough preoperative assessment is indicated when presented with dislocated HA to prevent further complications.
由于虚弱、合并症、骨和软组织质量差，髋关节半髋关节置换术后脱位仍然是一种难以治疗的疾病。我们旨在确定导致髋关节半髋关节置换术后不稳定的参数，并描述手术管理和患者预后。
我们回顾性地审查了 2004 年至 2019 年期间在一家三级保健机构接受治疗的所有髋部骨折患者的连续病例。我们在年龄、性别和手术方法上对有和无髋关节脱位的患者进行了 1:2 的倾向匹配。我们回顾了髋关节置换术后脱位的危险因素，进行了影像学测量，并记录了脱位和进一步并发症的处理情况。
在接受髋关节半髋关节置换术的 1472 例患者中，我们在分析中纳入了 18 例（1.2%）至少发生 1 次脱位的患者。在确定的脱位中，分别有 13 例和 17 例发生在术后 1 个月和 3 个月内。痴呆和术前外侧中心边缘角低与脱位风险增加有关。脱位组（ = 9）的 2 年死亡率明显高于对照组（ = 2）（ = 0.0003）。18 例中的 9 例（50%）患者接受了初始闭合复位；这 9 例中的 5 例（56%）再次发生脱位，需要进一步治疗。18 例中有 6 例在首次脱位后接受了全髋关节置换术。最终随访时，18 例中有 2 例患者接受了 Girdlestone 手术。
本研究强调了与髋关节半髋关节置换术后脱位风险增加相关的患者因素。当髋关节半髋关节置换术后脱位时，需要进行彻底的术前评估，以防止进一步的并发症。
