A. Yalçın TABAK, Levent ÇELEBİ, Hasan H. MURATLI, M. Fırat YAĞMURLU, Cem N. AKTEKİN, ALİ BİÇİMOĞLU

Yüksek kalça çıkıklı hastalarda çimentosuz total artroplastisi: Subtrokanterik segmental rezeksiyon ile femoral kısaltma sonuçları

Amaç: Yüksek total kalça çıkığı nedeniyle çimentosuz total kalça artroplastisi uygulanan olgularda subtrokanterik segmental rezeksiyon ile femoral kısaltma sonuçları değerlendirildi. Çalışma planı: Yüksek total çıkığı ve gelşimsel kalça displazisi olan 16 hastanın (15 kadın, 1 erkek; ort. yaş 41; dağılım 22-55) 19 kalçasına şiddetli ağrı nedeniyle total kalça artroplastisi uygulandı. Tüm hastalarda subtrokanterik segmental rezeksiyon ile femoral kısaltma uygulandı ve asetabulum anatomik olarak restore edildi. Tüm hastalarda çimentosuz, vidalı asetabuler komponentler ve çimentosuz femoral komponentler kullanıldı. Fonksiyonel değerlendirme Harris kalça skoru ile yapıldı. Radyolojik değerlendirmede asetabuler komponent için De Lee ve Charnley ölçütleri, femoral komponent ise Gruen zonları ve Engh ölçütleri kullanıldı. Ortalama izlem süresi 44 ay (dağılım 22-79 ay) idi. Bulgular : Tüm hastalarda ortalama 14 haftada (dağılım 11 - 1 5 hafta) rezeksiyon hattında kaynama elde edildi. Ameliyat öncesinde ortalama 4 cm olan ekstremite eflitsizliği ameliyat sonrasında 1.5 cm bulundu. Ameliyat öncesinde 13 hastada görülen Trendelenburg bulgusu ameliyat sonrasında dört hastada gözlendi. Ameliyat öncesinde 37 puan olan Harris kalça skoru ortalaması, ameliyat sonrasında 83 puana yükseldi. Hiçbir hastada derin enfeksiyon, dislokasyon, siyatik sinir palsisi ve rezeksiyon hattında kaynamama durumu görülmedi; klinik ve radyolojik gevşeleme saptanmadı ve revizyon uygulanmadı.Çıkarımlar: Yüksek total dislokasyonlu gelişlimsel kalça displazisi olan hastalarda, total kalça artroplastisinde subtrokanterik segmental rezeksiyonla yapılan femoral kısaltma, güvenli ve fonksiyonel olarak tatminkar sonuçlar sağlayıcı bir yöntemdir.

Anahtar Kelimeler:

Artroplasti, replasman, kalça, Asetabulum, Kalça çıkığı, Ortopedik gereçler, Ortopedik işlemler, Osteotomi, Femur başı, Kalça protezi, Tedavi sonucu

Cementless total hip replacement in patients with high total dislocation: The results of femoral shortening by subtrochanteric segmental resection

Objectives: We evaluated the results of femoral shortening by subtrochanteric segmental resection in patients who underwent total hip replacement (THR) for high total dislocation of the hip. Methods: We performed THR in 19 hips of 16 patients (15 females, 1 male; mean age 41 years; range 22 to 55 years) with high total dislocation of the hip. All the patients had severe hip pain. In all cases, femoral shortening by subtrochanteric segmental resection and an anatomical reconstruction of the acetabulum were performed with the use of cementless femoral components and cementless acetabular components with screws, respectively. The Harris hip scoring system was used for functional assessments. Radiologic assessments were based on the DeLee and Charnley criteria for the acetabular component, and on the Gruen zones and the Engh criteria for the femoral component. The mean follow-up period was 44 months (range 22 to 79 months). Results: Union was achieved in all cases in a mean of 14 weeks (range 11 to 15 weeks). The mean leg length discrepancy decreased from 4 cm to 1.5 cm postoperatively. A positive Trendelenburg sign was found in 13 patients and four patients before and after surgery, respectively. The mean Harris hip score improved from 37 to 83 postoperatively. None of the patients developed deep infection, dislocation, sciatic nerve palsy, or nonunion at the osteotomy site. No clinical and radiologic signs of loosening were observed and no revisions were required. Conclusion: Femoral shortening with subtrochanteric segmental resection in THR is a safe technique in patients with high total dislocation of the hip, leading to satisfactory functional results.

Keywords:

Arthroplasty, Replacement, Hip, Acetabulum, Hip Dislocation, Orthopedic Equipment, Orthopedic Procedures, Osteotomy, Femur Head, Hip Prosthesis, Treatment Outcome,

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