Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration
Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration
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DOI：
10.1016/s0883-5403(98)90052-3
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发表时间：
1998-08-01
影响因子：
3.5
通讯作者：
Sheehan, LJ
中科院分区：
文献类型：
--
作者：
Kennedy, JG;Rogers, WB;Sheehan, LJ
我们回顾性回顾了75例全髋关节置换术，以研究髋臼假体位置的影响。A组38个假体按说明书植入，所有外周鳍与髋臼骨接触；因此，髋臼各部件处于相对垂直的位置，平均倾斜角度为61.9度。其中3名患者发生复发性脱位，需要对髋臼部件进行翻修。在B组，37髋，尽管髋臼组件的所有外周鳍没有接合髋臼骨，但仍采用更水平的方向；这组患者的平均倾斜角为49.7度。这些髋关节中只有一个复发脱位并需要翻修。本组未见因外周固定不充分引起的暂时性构件稳定性问题。所有患者术后4年（范围4.0-4.3年）的x线片。A组24%的髋部出现盆腔骨溶解，b组13%。A组5.1%的髋部出现不对称聚乙烯磨损；B组无髋部磨损不对称。19%的A组和5%的B组髋臼假体发生移位。两组患者髋关节Mayo临床评分均为优秀：A组71/80，B组73/80。在中期随访中，很明显，当将该组件放置在相对垂直的位置以促进所有四个外周鳍与骨的接合时，可能会遇到严重的问题。我们已经解决了这个问题，放置杯子在一个更解剖的位置倾斜，同时保持临时边缘固定。这降低了骨盆骨溶解的发生率，减少了并发症。
We retrospectively reviewed 75 total hip arthroplasties to examine the effect of acetabular component position. In group A, 38 of the components were implanted according to manufacture's instructions with all peripheral fins in contact with acetabular bone; as such, the acetabular components were in a relatively Vertical position with a mean angle of inclination of 61.9 degrees. Three of these patients developed recurrent dislocations necessitating revision of the acetabular component. In group B, 37 hips, a more horizontal orientation was used despite the faa that all of the peripheral fins of the acetabular component did not engage acetabular bone; in this group the mean angle of inclination was 49.7 degrees. Only one of these hips recurrently dislocated and required revision. There were no problems in this group associated with provisional component stability caused by inadequate peripheral fixation. Radiographs of all patients were obtained at 4 years after surgery (range, 4.0-4.3 years). Pelvic osteolysis had occurred in 24% of hips in group A and 13% of group B. Asymmetric polyethylene wear was observed in 5.1% of the hips in group A; no hip in group B showed wear asymmetry. Acetabular component migration developed in 19% of group A hips and 5% of group B hips. The Mayo clinical hip score was excellent in both groups: group A 71/80, group B 73/80. At an intermediate follow-up it is clear that significant problems can be encountered when this component is positioned in a relatively vertical position to facilitate engaging all four peripheral fins in bone. We have addressed this problem by placing the cup in a more anatomic position of inclination while maintaining provisional rim fixation. This has resulted in a decreased incidence of pelvic osteolysis and fewer complications overall.