Prior Instability is Strongly Associated With Dislocation After Isolated Head and Liner Exchange

医学 优势比 外科 股骨头 回顾性队列研究 体质指数 射线照相术 内科学
作者
Elyse J. Berlinberg,Mackenzie A. Roof,Ittai Shichman,Morteza Meftah,Ran Schwarzkopf
出处
期刊:Journal of Arthroplasty [Elsevier BV]
卷期号:37 (12): 2412-2419 被引量:2
标识
DOI:10.1016/j.arth.2022.06.019
摘要

Isolated head and liner exchange is an appealing alternative to a more extensive revision total hip arthroplasty in patients who have well-fixed components. Despite efforts to increase femoral offset and restore soft tissue tensioning, limited component revision may be associated with higher rates of postoperative instability.This retrospective analysis assessed 209 patients who had a head and liner exchange conducted at a large academic medical center between 2011 and 2019 and had >2 years of follow-up. Functional cup positioning within the Lewinnek safe zone was assessed on postoperative weight-bearing radiographs. Included patients were 56% women, had a mean age of 64 years (range, 24-89) and a mean body mass index of 28.8 kg/m2 (range, 18.2-46.7). The most common indications for surgery included acetabular liner wear in 86 hips (41%), instability in 40 hips (19%), and infection in 36 hips (17%).Twenty-eight hips (13%) had a dislocation within 2 years after surgery. The best-fit model predicting postoperative dislocation included a history of dislocation (adjusted-odds ratio [adj-OR] 5.67, 95% CI 2.39-14.09, P < .001), age (adj-OR 1.04 per 1-year increase, 95% CI 0.99-1.08, P = .10), and body mass index (adj-OR 0.90 per 1-kg/m2 increase, 95% CI 0.80-0.99, P = .046).In a large cohort of patients who had isolated head and liner exchange, patients who had prior instability had 7-fold elevated odds of postoperative dislocation. This risk remains significant after controlling for cup positioning outside the Lewinnek safe zone, liner type, head size, neck length, soft tissue compromise, neuromuscular disease, and dual mobility constructs.III, retrospective cohort study.
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