Kitamura Toshiki, Hayashi Shinya, Matsumoto Tomoyuki, Hashimoto Shingo, Nakano Naoki, Kuroda Yuichi, Niikura Takahiro, Kuroda Ryosuke
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, JPN.
Department of Orthopedics, Kobe University Graduate School of Medicine, Kobe, JPN.
Cureus. 2023 Nov 5;15(11):e48295. doi: 10.7759/cureus.48295. eCollection 2023 Nov.
Charcot arthropathy is a rapidly progressive and destructive form of arthropathy caused by various neurological diseases. Total hip arthroplasty (THA) is usually contraindicated in patients with Charcot arthropathy; however, recent studies have reported good results following THA in this patient population. Herein, we report a case of Charcot arthropathy secondary to syphilis in a patient who was successfully treated with constrained THA, a new type of THA. A 56-year-old man was injured in a car accident, and a displaced acetabular fracture was revealed three weeks later. He was treated conservatively but soon developed greater displacement of the fracture and femoral head destruction. The patient was referred to our hospital for further treatment. The patient had pelvic pseudarthrosis secondary to Charcot arthropathy at the time of the first visit to our hospital. First, THA was performed with the acetabular reconstruction of the deficient bone. However, the acetabular implant was displaced one week postoperatively. THA revision was performed using a constrained cup. Postoperatively, the patient exhibited good hip stability without dislocation. However, displacement of the acetabular cup occurred one year after the second surgery. We performed a re-revision of THA using a new type of constrained cup that offers a high level of constraint to maintain range of motion (ROM) and prevent dislocations. The patient was able to walk with a T-cane one year postoperatively. Herein, we report a difficult case of revision THA in a patient with Charcot arthropathy concomitant with syphilis. THA is usually contraindicated in patients with Charcot arthropathy; however, we propose that THA using constrained cups that offer a wider ROM may be a useful therapeutic strategy for the treatment of Charcot arthropathy.
夏科氏关节病是一种由各种神经疾病引起的快速进展且具有破坏性的关节病形式。全髋关节置换术（THA）在夏科氏关节病患者中通常是禁忌的；然而，最近的研究报告了在这一患者群体中进行THA后取得的良好效果。在此，我们报告一例梅毒继发的夏科氏关节病患者，该患者成功接受了一种新型THA——限制性THA治疗。一名56岁男性在车祸中受伤，三周后发现髋臼骨折移位。他接受了保守治疗，但很快骨折移位加剧且股骨头出现破坏。该患者被转诊至我院进一步治疗。首次就诊时，患者因夏科氏关节病继发骨盆假关节。首先，进行了THA并对缺损骨进行髋臼重建。然而，术后一周髋臼假体发生移位。使用限制性髋臼杯进行了THA翻修手术。术后，患者髋关节稳定性良好，未发生脱位。然而，第二次手术后一年髋臼杯再次移位。我们使用一种新型的高限制性髋臼杯对THA进行了再次翻修，以维持活动范围（ROM）并防止脱位。术后一年，患者能够借助丁字拐行走。在此，我们报告一例伴有梅毒的夏科氏关节病患者进行THA翻修的疑难病例。THA在夏科氏关节病患者中通常是禁忌的；然而，我们认为使用能提供更广泛ROM的限制性髋臼杯进行THA可能是治疗夏科氏关节病的一种有用的治疗策略。
