Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, 573-1010, Osaka, Japan.
BMC Musculoskelet Disord. 2023 Mar 29;24(1):238. doi: 10.1186/s12891-023-06355-4.
There are many therapeutic options for dislocation following total hip arthroplasty (THA). The aim of this study was to evaluate the results of revision surgery for dislocated hips.
Between November 2001 and December 2020, 71 consecutive revision hip surgeries were performed at our institution for recurrent dislocation following THA. We conducted a retrospective study of all 65 patients (71 hips), who were followed for a mean of 4.7 ± 3.2 years (range, 1-14). The cohort included 48 women and 17 men, with a mean age of 71 ± 12.3 years (range, 34-92). The mean number of previous surgeries was 1.6 ± 1.1 (range, 1-5). From intraoperative findings, we created six categories of revision hip surgery for recurrent dislocation following THA: open reduction and internal fixation (2 hips); head change or liner change only (6 hips); cup change with increased head size only (14 hips); stem change only (7 hips); cup and stem change (24 hips); and conversion to constrained cup (18 hips). Prosthesis survival was analyzed by the Kaplan-Meier method, with repeat revision surgery for re-dislocation or implant failure as the endpoint. A cox proportional hazards model was used for risk factors of re-revision surgery.
Re-dislocation occurred in 5 hips (7.0%) and implant failure in 1 hip (1.4%). The 10-year survival rate was 81.1% (95% confidence interval, 65.5-96.8). A Dorr classification of "positional" was a risk factor for re-revision surgery due to re-dislocation.
Clear understanding of the cause of dislocation is essential for optimizing revision procedures and improving the rate of successful outcomes.
全髋关节置换术后（THA）脱位有许多治疗选择。本研究旨在评估髋关节翻修术治疗髋关节脱位的效果。
2001 年 11 月至 2020 年 12 月，我院对 71 例 THA 后复发性髋关节脱位患者进行了 71 例髋关节翻修手术。我们对所有 65 例患者（71 髋）进行了回顾性研究，平均随访 4.7±3.2 年（范围，1-14 年）。该队列包括 48 名女性和 17 名男性，平均年龄 71±12.3 岁（范围，34-92 岁）。平均既往手术次数为 1.6±1.1 次（范围，1-5 次）。根据术中发现，我们将 THA 后复发性髋关节脱位的髋关节翻修术分为六类：切开复位内固定（2 髋）；单纯更换股骨头或衬垫（6 髋）；单纯更换大直径股骨头（14 髋）；单纯更换假体柄（7 髋）；更换髋臼和假体柄（24 髋）；转换为约束杯（18 髋）。采用 Kaplan-Meier 法分析假体生存率，以重复翻修手术治疗复发性脱位或假体失败为终点。采用 Cox 比例风险模型分析再次翻修手术的危险因素。
5 髋（7.0%）发生再脱位，1 髋（1.4%）发生假体失败。10 年生存率为 81.1%（95%置信区间，65.5%-96.8%）。Dorr 分类为“位置性”是再次翻修手术导致再脱位的危险因素。
明确脱位的原因对于优化翻修手术程序和提高成功率至关重要。
