Nakata K, Ohzono K, Masuhara K, Matsui M, Hiroshima K, Ochi T
Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Japan.
J Bone Joint Surg Br. 1997 Mar;79(2):258-64. doi: 10.1302/0301-620x.79b2.7181.
We have reviewed 65 bipolar arthroplasties of the hip in 55 patients with osteoarthritis secondary to dysplasia. The mean age at operation was 56 years (42 to 79) and the mean period of follow-up was 7.2 years (5.0 to 13.0). The average Merle d'Aubigné and Postel score before operation was 10.3 and at final follow-up 15.0. There were excellent or good results in 42 hips (65%). Migration of the outer head was observed in 50 hips (77%), most often in the group with a centre-edge angle of less than 0 degrees, an acetabular head index of less than 60%, coverage of the outer head by the original acetabulum of less than +10 degrees and after bone grafting of the acetabulum. This migration was progressive in 31 (62%) of the 50 hips, with massive osteolysis of the acetabulum in eight. The extent and progression of migration were closely associated with this osteolysis. Four hips required revision for extensive migration of the outer head with destruction of the acetabulum or severe acetabular osteolysis, and nine hips are awaiting revision for failure of the bipolar prosthetic head. The overall failure rate was 18%. We report major problems after bipolar hip arthroplasty for osteoarthritis secondary to hip dysplasia with progressive migration of the outer head and massive acetabular osteolysis at five years or more after operation.
我们回顾了55例发育异常继发骨关节炎患者的65例双极髋关节置换术。手术时的平均年龄为56岁（42至79岁），平均随访时间为7.2年（5.0至13.0年）。术前平均Merle d'Aubigné和Postel评分为10.3分，末次随访时为15.0分。42髋（65%）获得了优良结果。50髋（77%）观察到股骨头外移，最常见于中心边缘角小于0度、髋臼头指数小于60%、原髋臼对股骨头的覆盖小于+10度以及髋臼植骨后的患者。在这50髋中，31髋（62%）的外移呈进行性，其中8髋出现髋臼大量骨溶解。外移的程度和进展与这种骨溶解密切相关。4髋因股骨头外移广泛伴髋臼破坏或严重髋臼骨溶解而需要翻修，9髋因双极假头失败而等待翻修。总体失败率为18%。我们报告了发育异常继发骨关节炎患者行双极髋关节置换术后的主要问题，即术后5年或更长时间出现股骨头外移进展和髋臼大量骨溶解。
