Nakata K, Ohzono K, Hiroshima K
Department of Orthopaedics, Osaka National Hospital, Suita, Japan.
Clin Orthop Relat Res. 1994 Jul(304):156-64.
Seventy-one hips with osteoarthritis secondary to congenital dislocation underwent bipolar arthroplasty with autologous bone grafting (grafted group) or without bone grafting (ungrafted group). Clinical and radiographic followup was performed; the average followup was 5.7 years (range, 3-11.3 years). At followup, the mean Merle d'Aubigné and Postel score was 14.3 points. Excellent or good results were achieved in only 50% of all cases. The mean extent of prosthetic head migration was 6.5 mm in the grafted group and 4.7 mm in the ungrafted group. Progressive migration occurred in 68% of the grafted group and in 43% of the ungrafted group. There was a significant negative correlation between the extent of migration of the outer head and the coverage of the outer head by the original acetabulum (R = 0.53). In the grafted group, the revision rate for failure of the outer head of the prosthesis was 60% at 6 years postoperatively. In the grafted group, progressive migration was more extensive and more frequently than in the ungrafted group. Extensive migration was also observed when there was adequate coverage of the outer head by host bone in the ungrafted group. In conclusion, bipolar arthroplasty is not recommended for osteoarthritis secondary to congenital hip dislocation because of the poor clinical outcome, high risk of significant progressive migration, and high revision rate.
71例先天性脱位继发骨关节炎的髋关节接受了带自体骨移植的双极关节成形术（移植组）或未进行骨移植的双极关节成形术（未移植组）。进行了临床和影像学随访；平均随访时间为5.7年（范围3 - 11.3年）。随访时，Merle d'Aubigné和Postel平均评分为14.3分。所有病例中仅有50%取得了优良结果。移植组假体头移位的平均程度为6.5mm，未移植组为4.7mm。移植组68%出现了渐进性移位，未移植组为43%。假体外侧头移位程度与原髋臼对外侧头的覆盖程度之间存在显著负相关（R = 0.53）。在移植组，术后6年假体外侧头失败的翻修率为60%。移植组的渐进性移位比未移植组更广泛、更频繁。在未移植组中，当宿主骨对外侧头有足够覆盖时也观察到了广泛移位。总之，由于临床结果不佳、显著渐进性移位风险高以及翻修率高，不推荐对先天性髋关节脱位继发的骨关节炎行双极关节成形术。
