Leclercq S, el Blidi S, Aubriot J H
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(5):389-94.
Dislocation following total hip arthroplasty (THA) continues to be a problem. An innovative treatment is described with the intermediate Bousquet's prosthesis. This study reported 13 cases and demonstrates its high reliability despite the origins of the dislocation. Recurrent dislocation following initial dislocation, occurs in between 25 to 60 per cent of the cases reported in the literature. The main cause is a malpositioned prosthetic component and especially a retroverted acetabulum. The other reasons for dislocation were: trochanteric non-union, bone or cement impingement, previous surgery, age and neurologic disorder. In every case the instability of the hip may be caused or increased by muscular insufficiency. Various methods are described to control recurrent dislocation: repositioning the component, posterior acetabular wall component, trochanteric advancement, retentive acetabular component, bracing. When the cause is clear and isolated, the rate of success may be 70-80 per cent. This study examines the results of a revision procedure with the intermediate Bousquet's prosthesis.
13 recurrent dislocations were treated with the intermediate Bousquet's prosthesis. There were 10 women and 3 men with an average age at operation of 73 years. The main cause in 7 cases was an abductor insufficiency including 4 trochanteric non unions. The other causes were 6 component malpositions, 7 previous surgery, 1 impingement. The average delay between the first dislocation and revision was one year. The Bousquet's acetabular component is an steel cup covered with alumina, impacted without cement. The polyethylene component is free in the cup and retentive on the femoral head. The femoral positioning was not modified.
The revision did not correct all of the causes of luxation, however we noted only one case of dislocation and no recurrent dislocations.
At last follow-up, all recurrent dislocations were controlled. Nevertheless, there remained 7 abductor insufficiencies and 4 femoral malpositionings. In the literature the rate of success depends on the cause. The main difficulty is the treatment of joint laxity. Some authors propose trochanteric advancement, a larger head, a posterior wall acetabular component, retentive acetabular component. Success is not uniform. The Bousquet's acetabular component supports joint laxity and femoral malpositioning. This allows to keep the same original femoral component when the risk is too high for a cemented prosthesis or impossible for a non cemented prosthesis.
This treatment of the recurrent dislocation is reliable with a short and simple operation.
全髋关节置换术（THA）后脱位仍是一个问题。本文描述了一种使用中间型布凯假体的创新治疗方法。本研究报告了13例病例，并证明了其尽管存在脱位原因但仍具有高可靠性。文献报道中，初次脱位后复发性脱位发生在25%至60%的病例中。主要原因是假体组件位置不当，尤其是髋臼后倾。脱位的其他原因包括：转子不愈合、骨或骨水泥撞击、既往手术、年龄和神经疾病。在每种情况下，髋关节的不稳定可能由肌肉功能不全引起或加重。描述了各种控制复发性脱位的方法：重新定位组件、髋臼后壁组件、转子推进、髋臼固定组件、支具。当原因明确且单一，成功率可能为70%-80%。本研究检查了使用中间型布凯假体的翻修手术结果。
13例复发性脱位采用中间型布凯假体治疗。其中女性10例，男性3例，平均手术年龄73岁。7例的主要原因是外展肌功能不全，包括4例转子不愈合。其他原因包括6例组件位置不当、7例既往手术、1例撞击。初次脱位与翻修之间的平均间隔时间为1年。布凯髋臼组件是一个覆盖有氧化铝的钢杯，无骨水泥植入。聚乙烯组件在钢杯内自由活动并固定在股骨头。股骨位置未改变。
翻修并未纠正所有脱位原因，但我们仅记录到1例脱位，且无复发性脱位。
在最后一次随访时，所有复发性脱位均得到控制。然而，仍存在7例外展肌功能不全和4例股骨位置不当。文献中成功率取决于原因。主要困难在于关节松弛的治疗。一些作者提出转子推进、更大的股骨头、髋臼后壁组件、髋臼固定组件。成功率并不一致。布凯髋臼组件可支持关节松弛和股骨位置不当。当骨水泥假体风险过高或非骨水泥假体不可能时，这允许保留相同的原始股骨组件。
这种复发性脱位的治疗方法可靠，手术简短且简单。
