Torres-Ramirez Ricardo J, Rodriguez Jose A
Adult Reconstruction and Joint Replacement Department, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2025 Jul 21;34:101768. doi: 10.1016/j.artd.2025.101768. eCollection 2025 Aug.
Dislocation is a common complication after head and liner exchange. Although surgical approach has been shown to influence instability rate following primary total hip replacement, the same has not been demonstrated for head and liner exchange. The effect of additional soft tissue release to achieve exposure in revision surgery has been implicated in this finding. We have sought to describe and report the effects on postoperative stability of a capsular sparing technique of head and liner exchange with the direct anterior approach, in a single surgeon case series.
A retrospective study of all isolated head and liner exchanges with a capsular-sparing direct anterior approach was conducted from 2017 to 2022. Patients without a 2-year follow-up or prior revision on the ipsilateral hip were excluded. A total of 39 hips in 36 patients were identified, with the most common indication for HLE being, liner wear + osteolysis in 44% of patients. The mean follow-up was 29.8 months.
At the latest follow-up there were zero dislocations. Two patients required re-revision for acetabular component loosening, yielding a 95% survivorship free of re-revision at latest follow-up. A 36-mm head was utilized in 65% and a neutral liner in 85% percent of the hips. The average Hip Disability and Osteoarthritis Outcome Score for Joint Replacement score at latest follow-up was 80.81.
HLE with the DAA using a capsular sparing technique can yields favorable short-term outcomes with a 0% dislocation rate and a 95% survivorship free of re-revision at 2 years.
脱位是股骨头与内衬置换术后的常见并发症。尽管手术入路已被证明会影响初次全髋关节置换术后的不稳定率，但对于股骨头与内衬置换术而言，情况并非如此。在翻修手术中，为实现暴露而进行的额外软组织松解的影响与这一发现有关。我们试图在一个单术者病例系列中，描述并报告采用直接前路入路的保留关节囊的股骨头与内衬置换技术对术后稳定性的影响。
对2017年至2022年期间所有采用保留关节囊的直接前路入路进行的单纯股骨头与内衬置换手术进行回顾性研究。排除同侧髋关节无2年随访或既往有翻修史的患者。共确定了36例患者的39髋，股骨头与内衬置换最常见的指征是44%的患者出现内衬磨损+骨溶解。平均随访时间为29.8个月。
在最近一次随访时，脱位率为零。2例患者因髋臼组件松动需要再次翻修，在最近一次随访时，无再次翻修的生存率为95%。65%的髋关节使用了36毫米的股骨头，85%的髋关节使用了中性内衬。在最近一次随访时，髋关节置换的平均髋关节残疾和骨关节炎结果评分是80.81。
采用保留关节囊技术的直接前路入路进行股骨头与内衬置换，可产生良好的短期效果，2年时脱位率为0%，无再次翻修的生存率为95%。
