Ulf Gunther LEICHTLE, Carmen Ina LEICHTLE, Ferdane TASLACI, Patrik REIZE, Markus WÜNSCHEL

Dislocation after total hip arthroplasty: risk factors and treatment options

Amaç: Bu çalışmada primer ve revizyon total kalça protezi (TKP) sonrası ilk çıkık ve tekrarlayan çıkık olgularındaki risk faktörlerini değerlendirmek ve uygun tedavi yaklaşımını belirlemek amaçlandı. Çalışma planı: Çalışmaya 1984-2005 yılları arasında TKP yapılmış (n=5.205) ve sonrasında kalça çıkığı görülen 56 hasta ve bu grupla eşleştirilen 55 hastalık bir kontrol grubu dahil edildi. Her iki grubun hastane çizelgeleri ve radyografileri incelendi. Çalışma grubundan 31 hasta klinik ve radyolojik olarak takip edildi. Bulgular: Primer TKP sonrası çıkık görülme oranı %1.1 (56/5,205) iken, bu hastaların %39’u gibi yüksek bir oranda da tekrarlayan çıkık gözlendi. Ameliyatla ilk çıkık arasında geçen süre ile, ilk çıkık ile çıkığın tekrarlaması arasında geçen süre arasında pozitif bir korelasyon saptandı (r=0.4). Primer çıkıkların çoğu ameliyattan kısa bir süre sonra meydana geldiğinden sonraki çıkıklara da zemin hazırlamış oldular. Revizyon artroplastisi ve kadın cinsiyetin çıkık görülme riskini arttırdığı görüldü. Asetabuler kabın oryantasyonu ile çıkık arasında bir ilişki saptanmadı. Çıkarımlar: İlk çıkık sonrası tekrarlayan çıkıkların önlenmesi açısından cerrahi girişim gerektirecek olası teknik sorunların ciddi şekilde değerlendirilmesi gerektiğini düşünüyoruz. Yüksek nüks oranları dikkate alındığında, özellikle ilk TKP çıkığı sonrası sıkı bir konservatif tedavi uygulanmalıdır.

Total kalça protezi ameliyatı sonrası çıkıklarda risk faktörleri ve tedavi seçenekleri

Objective: The aim of this study was to analyze the setting for dislocations and redislocations after primary and revision total hip arthroplasty (THA), identify risk factors and optimize treatment. Methods: This study included 56 patients with a dislocated hip following THA (n=5,205) between 1984 and 2005 and a matched control group (n=55). Hospital charts and radiographs of all patients in both groups were analyzed. Thirty-one patients in the study group were followed both clinically and radiologically. Results: The dislocation rate after primary THA was 1.1% (56/5,205) and the redislocation rate after a first occurrence was as high as 39%. There was a positive correlation between the time intervals from the surgery to first dislocation and from the first dislocation to second dislocation (r=0.4). Most of the primary dislocations occurred within a short period of time after surgery, thus favoring consecutive dislocations. Female gender, as well as revision arthroplasty, was associated with a higher incidence of dislocations. No relation was found between the orientation of the acetabular cup and dislocation. Conclusion: To prevent redislocations after the first occurrence, we suggest thorough evaluation of possible technical faults which should be addressed surgically. Considering the high redislocation rate, we also advocate a stringent conservative treatment regime especially after the first THA dislocation.

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1. Buly RL, Huo MH, Salvati E, Brien W, Bansal M. Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases. J Arthroplasty 1992;7:315-23.
2. Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM. 2,012 total hip arthroplasties. A study of postoperative course and early complications. J Bone Joint Surg Am 1974; 56:273-84.
3. D'Antonio JA. Periprosthetic bone loss of the acetabulum. Classification and management. Orthop Clin North Am 1992;23:279-90.
4. Gächter A. Recurrent dislocation of the hip prosthesis. [Article in German] Orthopade 1989;18:533-9.
5. McCollum DE, Gray WJ. Dislocation after total hip arthro- plasty. Causes and prevention. Clin Orthop Relat Res 1990;(261):159-70.
6. Turner RS. Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management. Clin Orthop Relat Res 1994;(301):196-204.
7. Grossmann P, Braun M, Becker W. Dislocation following total hip endoprosthesis. Association with surgical approach and other factors. [Article in German] Z Orthop Ihre Grenzgeb 1994;132:521-6.
8. Fackler CD, Poss R. Dislocation in total hip arthroplasties. Clin Orthop Relat Res 1980;(151):169-78.
9. Nicholas RM, Orr JF, Mollan RA, Calderwood JW, Nixon JR, Watson P. Dislocation of total hip replacements. A com- parative study of standard, long posterior wall and augment- ed acetabular components. J Bone Joint Surg Br 1990;72: 418-22.
10. Paterno SA, Lachiewicz PF, Kelley SS. The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replace- ment. J Bone Joint Surg Am 1997;79:1202-10.
11. Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation fol- lowing total hip replacement. J Bone Joint Surg Br 1981;63: 214-8.
12. Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 2004; 86:9-14.
13. Dorr LD, Wan Z. Causes of and treatment protocol for instability of total hip replacement. Clin Orthop Relat Res 1998;(355):144-51.
14. Kohn D, Rühmann O, Wirth CJ. Dislocation of total hip endoprosthesis with special reference to various techniques. [Article in German] Z Orthop Ihre Grenzgeb 1997;135:40-4.
15. Lawton RL, Morrey BF. Dislocation after long-necked total hip arthroplasty. Clin Orthop Relat Res 2004;(422):164-6.
16. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978;60:217-20.
17. Mallory TH, Vaughn BK, Lombardi AV Jr, Kraus TJ. Prophylactic use of a hip cast-brace following primary and revision total hip arthroplasty. Orthop Rev 1988;17:178-83.
18. Morrey BF. Difficult complications after hip joint replace- ment. Dislocation. Clin Orthop Relat Res 1997;(344):179- 87.
19. Padgett DE, Warashina H. The unstable total hip replace- ment. Clin Orthop Relat Res 2004;(420):72-9.
20. Woo RY, Morrey BF. Dislocations after total hip arthroplas- ty. J Bone Joint Surg Am 1982;64:1295-306.
21. Lindberg HO, Carlsson AS, Gentz CF, Pettersson H. Recurrent and non-recurrent dislocation following total hip arthroplasty. Acta Orthop Scand 1982;53:947-52.
22. Beaulé PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent disloca- tion following total hip replacement. J Bone Joint Surg Am 2002;84:256-63.
23. Robinson RP, Simonian PT, Gradisar IM, Ching RP. Joint motion and surface contact area related to component posi- tion in total hip arthroplasty. J Bone Joint Surg Br 1997;79: 140-6.
24. Herrlin K, Selvik G, Pettersson H, Kesek P, Onnerfält R, Ohlin A. Position, orientation and component interaction in dislocation of the total hip prosthesis. Acta Radiol 1988;29: 441-4.
25. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop 2005;76:517-23.
26. Saxler G, Marx A, Vandevelde D, Langlotz U, Tannast M, Wiese M, et al. Cup placement in hip replacement surgery - A comparison of free-hand and computer assisted cup place- ment in total hip arthroplasty - a multi-center study. [Article in German] Z Orthop Ihre Grenzgeb 2004;142:286-91.
27. Ackland MK, Bourne WB, Uhthoff HK. Anteversion of the acetabular cup. Measurement of angle after total hip replace- ment. J Bone Joint Surg Br 1986;68:409-13.
28. D'Lima DD, Chen PC, Colwell CW Jr. Optimizing acetab- ular component position to minimize impingement and reduce contact stress. J Bone Joint Surg Am 2001;83-A Suppl 2 Pt 2:87-91.
29. Noble PC. Biomechanics of dislocation after total hip replacement. Curr Opin Orthop 2001;12:79-84.
30. Yuan L, Shih C. Dislocation after total hip arthroplasty. Arch Orthop Trauma Surg 1999;119:263-6.
31. Eftekhar NS. Dislocation and instability complicating low friction arthroplasty of the hip joint. 1976. Clin Orthop Relat Res 2006;453:1-5.
32. Hedlundh U, Hybbinette CH, Fredin H. Influence of surgi- cal approach on dislocations after Charnley hip arthroplasty. J Arthroplasty 1995;10:609-14.
33. Hedlundh U, Ahnfelt L, Hybbinette CH, Weckstrom J, Fredin H. Surgical experience related to dislocations after total hip arthroplasty. J Bone Joint Surg Br 1996;78:206-9.
34. Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am 1992;23:237-48. 35. Ritter MA. Dislocation and subluxation of the total hip replacement. Clin Orthop Relat Res 1976;(121):92-4.
36. Bader R, Steinhauser E, Scholz R, Simnacher M, Mittelmeier W. Experimental analysis of neutral, asymmet- ric and constraint liners for total hip replacement: investiga- tion of range of motion and protection against joint instabil- ity. [Article in German] Z Orthop Ihre Grenzgeb 2004; 142:577-85.
37. Dorr LD, Wolf AW, Chandler R, Conaty JP. Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res 1983;(173):151-8.
38. Pollard JA, Daum WJ, Uchida T. Can simple radiographs be predictive of total hip dislocation? J Arthroplasty 1995;10: 800-4.
39. Shrader MW, Parvizi J, Lewallen DG. The use of a con- strained acetabular component to treat instability after total hip arthroplasty. J Bone Joint Surg Am 2003;85:2179-83.
40. Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: a multivari- ate analysis. J Arthroplasty 2002;17:282-8.
41. Mallory TH, Lombardi AV Jr, Fada RA, Herrington SM, Eberle RW. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res 1999;(358):166-72.
42. Shapiro GS, Weiland D, Sculco TP, Padgett DE, Pellicci PM. The use of a constrained acetabular component for recurrent dislocation. Instr Course Lect 2001;50:281-7.
43. Joshi A, Lee CM, Markovic L, Vlatis G, Murphy JC. Prognosis of dislocation after total hip arthroplasty. J Arthroplasty 1998;13:17-21.
44. Daly PJ, Morrey BF. Operative correction of an unstable total hip arthroplasty. J Bone Joint Surg Am 1992;74:1334- 43.
45. von Knoch M, Berry DJ, Harmsen WS, Morrey BF. Late dislocation after total hip arthroplasty. J Bone Joint Surg Am 2002;84:1949-53.
46. Coventry MB. Late dislocations in patients with Charnley total hip arthroplasty. J Bone Joint Surg Am 1985;67:832-41.
47. Hedlundh U, Karlsson M, Ringsberg K, Besjakov J, Fredin H. Muscular and neurologic function in patients with recur- rent dislocation after total hip arthroplasty: a matched con- trolled study of 65 patients using dual-energy X-ray absorp- tiometry and postural stability tests. J Arthroplasty 1999;14: 319-25.
48. Giurea A, Zehetgruber H, Funovics P, Grampp S, Karamat L, Gottsauner-Wolf F. Risk factors for dislocation of a cement- less total hip endoprosthesis - a statistical analysis. [Article in German] Z Orthop Ihre Grenzgeb 2001;139:194-9.
49. DiGioia AM, Jaramaz B, Blackwell M, Simon DA, Morgan F, Moody JE, et al. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res 1998;(355):8-22.
50. Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res 1998;(354):70-81.
51. Leichtle U, Gosselke N, Wirth CJ, Rudert M. Radiologic evaluation of cup placement variation in conventional total hip arthroplasty. [Article in German] Rofo 2007;179:46-52.
52. Honl M, Schwieger K, Gauck CH, Lampe F, Morlock MM, Wimmer MA, et al. Comparison of total hip replacements cup orientation and position. Navigation vs. conventional manual implantation of hip prostheses. [Article in German] Orthopade 2005;34:1131-6.
53. Kristiansen B, Jørgensen L, Hölmich P. Dislocation follow- ing total hip arthroplasty. Arch Orthop Trauma Surg 1985;103:375-7.
54. Rössig S, Kohn D. Improved radiological imaging of acetab- ular screw socket. [Article in German] Z Orthop Ihre Grenzgeb 1996;134:36-43.
55. Mauerhan DR, Lonergan RP, Mokris JG, Kiebzak GM. Relationship between length of stay and dislocation rate after total hip arthroplasty. J Arthroplasty 2003;18:963-7.