Chan Gareth, Curlewis Keegan, Aladwan Rahmeh, Hook Samantha E, Rogers Benedict A, Ricketts David M, Stott Philip
University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Brighton and Sussex Medical School, Brighton, UK.
Hip Int. 2025 May;35(3):315-322. doi: 10.1177/11207000251326038. Epub 2025 Apr 14.
Hip hemiarthroplasties are performed in medically frail and/or comorbid patients who sustain a displaced intracapsular hip fracture. Dislocations occur in approximately 0.6-5.0% patients and are associated with worse outcomes, including mortality when compared against a similar cohort of patients who do not suffer a dislocation of their hemiarthroplasty.This study aimed to quantify the outcomes from the management of dislocated hip hemiarthroplasties in a cohort of contemporaneously used implants and the associated 1-year mortality.
A retrospective review of a prospectively collected database of 4116 consecutive patients treated with a cemented hip hemiarthroplasty, in which 63 dislocations were identified was performed.The outcomes of the management of each dislocation were quantified, including the number of dislocations sustained after a preceding successful closed reduction. 1-year mortality was ascertained and stratified for each treatment option.
63 patients with a dislocation of a cemented hip hemiarthroplasty performed for an intracapsular hip fracture were included. Closed reduction was unsuccessful in 72% of (31/43) patients who had a closed reduction of their first dislocation. Failure rates of a second closed reduction increased to 76.9% and 100.0% with a third closed reduction.1-year mortality rate after a dislocation was 46.0% for all patients and lowest in the cohort of patients who were treated with a revision arthroplasty (27.3%).
Closed reduction of dislocated hip hemiarthroplasty is associated with a high failure rate, especially after a second dislocation. Consideration should be made to perform a revision procedure after a second dislocation with a high suspicion for soft tissue repair failure and/or infection.
半髋关节置换术适用于因囊内髋关节骨折而身体虚弱和/或患有合并症的患者。脱位发生率约为0.6%-5.0%，与较差的预后相关，与未发生半髋关节置换术脱位的类似患者队列相比，包括死亡率。本研究旨在量化同期使用的植入物队列中脱位半髋关节置换术的治疗结果以及相关的1年死亡率。
对前瞻性收集的4116例接受骨水泥型半髋关节置换术患者的数据库进行回顾性分析，其中发现63例脱位。对每次脱位的治疗结果进行量化，包括首次成功闭合复位后再次脱位的次数。确定每种治疗方案的1年死亡率并进行分层。
纳入63例因囊内髋关节骨折行骨水泥型半髋关节置换术且发生脱位的患者。首次脱位进行闭合复位的患者中，72%（31/43）闭合复位失败。第二次闭合复位失败率增至76.9%，第三次闭合复位失败率为100.0%。所有患者脱位后的1年死亡率为46.0%，在接受翻修置换术治疗的患者队列中最低（27.3%）。
脱位半髋关节置换术的闭合复位失败率较高，尤其是在第二次脱位后。对于高度怀疑软组织修复失败和/或感染的第二次脱位，应考虑进行翻修手术。
