Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S300-S305. doi: 10.1016/j.arth.2023.05.034. Epub 2023 May 25.
Concerns have been voiced regarding how surgical approach impacts risk of dislocation after total hip arthroplasty (THA). This study investigated how surgical approach impacts rate, direction, and timing of dislocations following THA.
We conducted a retrospective review of 13,335 primary THAs from 2011 to 2020 and identified 118 patients with prosthetic hip dislocation. Patients were stratified into cohorts by surgical approach used during primary THA. Patient demographics, index THA acetabular cup positioning, number, direction, timing of dislocations, and subsequent revisions were collected.
Dislocation rate differed significantly between posterior approach (PA), direct anterior approach (DAA), and laterally-based approach (LA) (1.1 versus 0.7% versus 0.5%, P = .026). Rate of hips dislocating anteriorly was lowest in the PA group (19.2%) compared to LA (50.0%) and DAA groups (38.2%, P = .044). There was no difference in rate of hips dislocating posteriorly (P = .159) or multidirectional (P = .508) instability; notably 58.8% of dislocations in the DAA cohort occurred posteriorly. There were no differences in dislocation timing or revision rate. Acetabular anteversion was highest in the PA cohort compared to DAA and LA (21.5 versus 19.2 versus 11.7 degrees, P = .049).
After THA, patients in the PA group had a slightly higher dislocation rate compared to the DAA and LA groups. The PA group had a lower rate of anterior dislocation and nearly 60% of DAA dislocations occurred posteriorly. However, with no differences in other parameters including revision rates or timing, our data suggests surgical approach may impact dislocation characteristics to a lesser degree than previous studies have suggested.
人们对髋关节置换术后（THA）的手术入路如何影响脱位风险表示担忧。本研究调查了手术入路如何影响 THA 后脱位的发生率、方向和时间。
我们对 2011 年至 2020 年的 13335 例初次 THA 进行了回顾性研究，确定了 118 例人工髋关节脱位患者。根据初次 THA 时使用的手术入路将患者分为队列。收集患者的人口统计学资料、髋臼杯的位置、数量、脱位方向、时间和随后的翻修情况。
后路入路（PA）、直接前路入路（DAA）和外侧入路（LA）的脱位率差异有统计学意义（1.1%比 0.7%比 0.5%，P=0.026）。PA 组髋关节向前脱位的发生率最低（19.2%），与 LA（50.0%）和 DAA 组（38.2%）相比，差异有统计学意义（P=0.044）。向后脱位（P=0.159）或多方向不稳定的发生率无差异（P=0.508）；值得注意的是，DAA 组中有 58.8%的脱位发生在后方。脱位时间或翻修率无差异。PA 组髋臼前倾角高于 DAA 和 LA 组（21.5 比 19.2 比 11.7 度，P=0.049）。
THA 后，PA 组患者的脱位率略高于 DAA 和 LA 组。PA 组向前脱位的发生率较低，近 60%的 DAA 脱位发生在后方。然而，由于翻修率和时间等其他参数无差异，我们的数据表明手术入路对脱位特征的影响程度小于先前研究的提示。
