Low Early and Late Dislocation Rates with 36- and 40-mm Heads in Patients at High Risk for Dislocation
Low Early and Late Dislocation Rates with 36- and 40-mm Heads in Patients at High Risk for Dislocation
复制标题
DOI：
10.1007/s11999-012-2379-3
复制
发表时间：
2013-02-01
影响因子：
4.2
通讯作者：
Soileau, Elizabeth S.
中科院分区：
文献类型：
--
作者：
Lachiewicz, Paul F.;Soileau, Elizabeth S.
大采用36 mm和40 mm股骨头和高交联聚乙烯内衬，以降低初次全髋关节置换术（THA）后脱位的风险，但尚不清楚风险是否降低，是否存在骨质溶解或内衬断裂。因此，我们确定了（1）早期和晚期（> 5年）脱位;（2）股骨和髋臼部件松动和翻修率;（3）内衬断裂和骨盆骨质溶解率。我们回顾性分析了112例假定脱位风险高的患者，他们接受了122例初次THA：108例使用36 mm股骨头，14例使用40 mm股骨头。风险因素包括：年龄> 75岁（80例髋关节）;股骨近端骨折（18例）;对侧脱位史（2例）;酗酒史（2例）;髋臼大> 60 mm（6例）;其他（14例）。对患者早期（< 1年）和晚期（> 5年）脱位、再手术率、Harris髋关节评分的临床结果以及放射线和骨质溶解的标准影像学分析进行评估。早期脱位率为4%（122个髋关节中的5个），所有髋关节均为36 mm股骨头。随访5 ~ 10年的74例髋关节无晚期脱位，无髋臼或股骨松动翻修，无内衬断裂。没有髋关节发生骨盆骨质溶解，7个髋关节出现髋臼放射线。在接受初次THA的高风险患者中，36 mm和40 mm股骨头的脱位风险较低，无骨质溶解或内衬断裂。IV级，治疗研究。有关证据等级的完整描述，请参见作者指南。
Large (36- and 40-mm) femoral heads with highly crosslinked polyethylene liners were introduced to reduce the risk of dislocation after primary total hip arthroplasty (THA), but it is unclear whether the risk is reduced and whether there is osteolysis or liner fracture.We therefore determined (1) the incidence of early and late (> 5 years) dislocation; (2) the rate of femoral and acetabular component loosening and revision; and (3) the rate of liner fracture and pelvic osteolysis.We retrospectively reviewed 112 patients presumed at high risk for dislocation who had 122 primary THAs: 108 with 36-mm and 14 with 40-mm femoral heads. The risk factors were: age > 75 years (80 hips); proximal femur fracture (18); history of contralateral dislocation (two); history of alcohol abuse (two); large acetabulum > 60 mm (six); and other (14). Patients were evaluated for early (< 1 year) and late (> 5 years) dislocation; rate of reoperation; clinical result with Harris hip score; and standard radiographic analysis for radiolucent lines and osteolysis.The rate of early dislocation was 4% (five of 122 hips), all with a 36-mm head. There were no late dislocations in 74 hips followed for 5 to 10 years, no revision for acetabular or femoral loosening, and no liner fractured. There were no hips with pelvic osteolysis and seven hips with an acetabular radiolucent line.The 36- and 40-mm femoral heads were associated with a low risk of dislocation in high-risk patients undergoing primary THA with no osteolysis or liner fracture.Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.