人工髋关节置换术中并发症分析

[目的]对人工髋关节置换手术并发症的病例进行分析,总结经验。[方法]1998年3月～2009年11月共行初次人工髋关节置换术62例(62髋),根据手术失败的原因进行分类并分析。[结果]根据病例统计,常见的失败原因与手术中正确操作与否有关,其次为骨折、麻醉、骨质疏松、糖尿病合并脑出血。共5例,其中术中猝死1例,股骨骨折1例,双下肢不等长1例,假体脱位2例。[结论]人工髋关节置换术作为髋关节重建的一种有效的治疗方法而得到广泛的应用,其长期可靠的疗效与手术中正确操作、术前准备工作,患者个体差异等因素有关。     

髋关节置换术后股骨假体周围骨折的治疗

目的探讨人工髋关节置换术后股骨假体周围骨折的有效处理方法。方法对7例人工髋关节置换术后股骨假体周围骨折进行手术,包括人工全髋关节翻修术、人工全髋关节翻修术加锁定钢板固定术、环抱器固定术以及锁定钢板固定术等几种手术方法。结果 7例病例均得到随访,随访时间6个月~4年,骨折愈合时间为2~6个月,平均3.5个月。手术前髋关节H arris平均分值为84分,术后髋关节为78分,无骨折不愈合、松动、假体感染及深静脉栓塞形成。结论髋关节置换术后股骨假体周围骨折的处理,应根据骨折类型、骨骼的质量及患者的经济情况等选择不同的治疗方法。     

髋关节置换术中假体周围骨折12例报告

目的 分析髋关节置换术中并发假体周围骨折的原因及防治措施.方法 自1999年5月～2010年9月,笔者施行人工髋关节置换术385例,共12例发生术中假体周围骨折,其中全髋关节置换术7例,髋关节翻修术4例,股骨头置换1例.全部病例术中均同期内固定.结果 11例获得随访,平均随访时间17.3个月(9～28个月),骨折均骨性...     

髋关节人工假体置换术后感染与对策

目的： 为了寻找髋关节人工假体置换术后感染最佳对策。方法： 对１９７６ 年１０ 月～１９９８ 年２ 月治疗的髋关节人工假体置换术后感染１０ 例进行回顾性分析。结果： １０ 例中７ 例属于早期感染， 其中１ 例死于糖尿病、２ 例经闭合冲洗感染得以控制、３ 例翻修、１ 例融合。１０ 例中３ 例晚期感染闭合冲洗无效。感染假体是否取出要看有无松动。最好对策还是加强预防。     

人工髋关节初次置换术后失败翻修策略分析

目的探讨人工髋关节初次置换术后失败的原因和翻修策略。方法 2009年3月至2014年4月,对86例人工髋关节初次置换术后失败的患者进行全髋关节翻修术,其中男33例,女53例;平均年龄64.3岁(45~81岁)。距初次置换术时间为1~16年,平均8.6年。翻修原因:无菌性松动54例,复发性脱位6例,假体周围骨折8例,感染17例,假体断裂1例。对所有患者进行术前、术后髋关节功能检查和Harris评分、影像学分析。结果所有病例均获随访8~59个月,平均38.9个月,无假体松动、脱位、感染等并发症;关节活动度明显改善,术前Harris评分平均42分(30~53分),末次随访时平均89分(73~97分),其中优51例,良29例,可6例,优良率93.02%;影像学评价:所有患者至末次随访时,术后X线片显示无假体移位下沉,假体周围无透亮带。结论人工髋关节置换术后失败原因很多,手术技巧和假体的选择是全髋关节翻修术成功的关键。     

人工髋关节置换术并发股骨骨折临床分析

目的探讨人工髋关节置换术并发股骨骨折的病因、治疗及预防。方法总结本院１９７２年４月～１９９６年６月行人工髋关节置换术９４５例，其中人工髋关节翻修术１４２例，初次人工髋关节置换术４９３例，人工股骨头置换３１０例。结果术中共发生股骨骨折２５例，总发生率为２．６％，其中人工髋关节翻修术８例，初次人工髋关节置换术１２例，人工股骨头置换５例。结论骨质疏松、医源性、先天性的股骨解剖结构改变以及软组织松解不彻底是发生术中骨折的主要原因。以下措施可有效地预防术中骨折的发生：（１）术前测量髓腔的大小，选择合适的假体；（２）彻底松解髋周软组织，脱位或复位时避免暴力；（３）用长假体应充分扩大髓腔；（４）假体置入时如遇有阻力，应避免强力打入，如突然有突破感，应考虑可能有骨折，应术中透视或照像。     

双极髋关节假体在髋部重建术中的应用

本文报告采用双极髋关节假体置换术治疗髋关节疾患共５９例，患者平均年龄５８．１岁。在获得随访的３５例中，随访时间１．５～５，８年（平均３．６年），临床疗效满意。本文着重讨论双极髋关节假体的生物力学特征，手术指征，手术要点及假体并发症的防治。我们认为双极假体设计合理，机械性失败少，可提供髋关节良好的功能与稳定性。但是，该置换术毕竟是对人体髋关节解剖与功能上的模拟，有一定的并发症。因此，掌握好手术指征甚为重要     

人工髋关节置换术治疗内固定失败的髋部骨折

目的探讨挽救性人工髋关节置换术的疗效。方法1995年1月至2007年12月，对11例髋部骨折内固定治疗失败的患者（股骨颈骨折7例，股骨粗隆问骨折4例）进行回顾性研究，分析其内固定治疗失败的原因，总结这11例患者行人工髋关节置换术的疗效。结果髋部骨折内固定治疗失败的主要原因是复位不良、内固定技术错误。10例患者获平均12个月（2～27个月）随访。无感染、脱位、假体松动下沉及假体周围骨折等并发症发生。10例患者髋关节功能均有改善，Harris评分由术前平均34.5分提高到术后84.2分。结论骨折复位不良、错误的内固定技术是髋部骨折治疗失败的重要原因。进行挽救性的人工髋关节置换手术对恢复患者髋关节功能临床疗效满意。     

人工髋关节置换术后翻修原因分析及预防

目的对人工髋关节翻修病例进行回顾性分析,总结经验,以便规范手术操作,提高远期疗效。方法总结自1999~2010年,对78例80髋行全髋关节翻修术,分析翻修原因。初次关节置换类型:全髋关节置换40例,单极股骨头置换12例,双极股骨头置换26例。翻修距初次手术时间:1年内11髋,1～2年6髋,5～10年42髋,10～17年21髋。结果根据本组统计,翻修常见原因依次为假体无菌性松动、髋臼磨损、假体位置不良、术后感染、假肢周围骨折、人工关节脱位及假体断裂,而且其中某些病例失败原因往往存在合并症。结论人工髋关节置换术作为髋关节重建的一种有效方法,其远期疗效有赖于适当的假体及手术方式的选择、正确的手术操作以及出现并发症后的合理治疗。     

髋臼周围肿瘤切除人工假体置换术

[目的]探讨髋臼周尉肿瘤切除人工假体置换术的手术方法及并发症分析。[方法]回顾1996年10月～2001年11月，采用肿瘤切除人工假体置换术治疗髋臼周围恶性肿瘤2例。[结果]随访时间分别7a5个月，3a4个月，其中1例术后肿瘤复发，并出现假体松动，另1例术后感染，并出现假体松动，髋关节脱位。[结论]髋臼周围肿瘤切除人工似体置换术后并发症较多，临床应用需慎重，手术医院的综合能力也是必须考虑的，勉强手术所带来的结果有时是灾难性的。     

Results and experiences of conversion of hip arthrodesis

INTRODUCTION: With the predictably good outcome of total hip arthroplasty today (THA), hip arthrodesis currently has limited indications. Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and ipsilateral knee due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires conversion of a fused hip to a THA. The results and experiences of conversions of a hip arthrodesis into a THA are reported. INTRODUCTION: Between 1 January 1985 and 31 December 2001 conversion of a previously performed arthrodesis of the hip to THA was carried out in a total of 45 patients; 34 patients could be followed up after the conversion to THA after a mean of 77.5 months (min.: 24, max.: 208). The primary indications for the conversion were low back pain (n=21) and ipsilateral knee pain (n=13). RESULTS: The mean age at the time of THA was 75.3 years (min.: 32, max.: 74). The mean time interval between the arthrodesis and the conversion to THA was 30.4 years (min.: 5, max.: 66). Of 34 hips, 29 (85%) were either pain free or had minimal pain. Complications included one persisting sciatic nerve palsy, two superficial infections, two periprosthetic fractures, and two heterotopic ossifications IV degrees with one recurrence of ankylosis and one marked reduction of motion. Revision arthroplasty was performed in four hips. Postoperatively 7 patients showed no limping, 11 showed a slight limp, and 17 a pronounced limp. Recurrent dislocations occurred in one patient. CONCLUSION: We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. There is a high rate of complications after conversion of a hip arthrodesis to a total hip arthroplasty. These issues must be carefully considered and discussed with the patient before any conversion procedure.     

Total hip arthroplasty following failed fixation of proximal hip fractures

Background:

Most proximal femoral fractures are successfully treated with internal fixation but a failed surgery can be very distressing for the patient due to pain and disability. For the treating surgeon it can be a challenge to perform salvage operations. The purpose of this study was to evaluate the short-term functional outcome and complications of total hip arthroplasty (THA) following failed fixation of proximal hip fracture.

Materials and Methods:

In a retrospective study, 21 hips in 20 patients (13 females and seven males) with complications of operated hip fractures as indicated by either established nonunion or fracture collapse with hardware failure were analysed. Mean age of the patients was 62 years (range 38 years to 85 years). Nine patients were treated for femoral neck fracture, 10 for intertrochanteric (I/T) fracture and two for subtrochanteric (S/T) fracture of the hip. Uncemented THA was done in 11 cases, cemented THA in eight hip joints and hybrid THA in two patients.

Results:

The average duration of follow-up was four years (2-13 years). The mean duration of surgery was 125 min and blood loss was 1300 ml. There were three dislocations postoperatively. Two were managed conservatively and one was operated. There was one superficial infection and one deep infection. Only one patient required a walker while four required walking stick for ambulation. The mean Harris Hip score increased from 32 preoperatively to 79 postoperatively at one year interval.

Conclusion:

Total hip arthroplasty is an effective salvage procedure after failed osteosynthesis of hip fractures. Most patients have good pain relief and functional improvements inspite of technical difficulties and high complication rates than primary arthroplasty.     

Total hip arthroplasty in young adults after failed triple innominate osteotomy

This study compared the results of total hip arthroplasty (THA) in 11 patients with 13 hips who underwent THA after a failed triple innominate osteotomy (TIO) with an age-matched and sex-matched group of patients who underwent THA without prior TIO. The average age at the time of THA was 37 years (range, 16-50 years). The average follow-up of the patients who underwent THA for failed TIO was 36 months and for the control group was 28 months. One hip in each group underwent revision for dislocation. At final follow-up, the average Harris hip score in the study group was 76, whereas in the control group it was 88 (P <.05). The pain component of the Harris hip score in the study group averaged 32, whereas in the control group it averaged 40 (P <.05). Functional scores between the 2 groups were similar. Radiographically, there was no difference between the 2 groups. Estimated blood loss for the hips performed for failed TIO averaged 721 mL, whereas in the control group the estimated blood loss averaged 448 mL (P <.05). There was no difference in operative time. The results of this study indicated that although the radiographic results of THA after TIO are equivalent to THA without prior TIO, clinical results in terms of pain relief and the technical difficulty of THA are not equivalent to results in young adult patients who undergo THA without prior TIO.     

Short-term outcomes of total hip arthroplasty after complications of open reduction internal fixation for hip fracture

Failed open reduction internal fixation (ORIF) of the proximal femur can render patients severely disabled. This study analyzed the short-term functional results and complications of total hip arthroplasty (THA) for complications of ORIF after hip fracture. A retrospective arthroplasty database review identified 36 patients treated with a THA for complications of ORIF of the hip. These patients were matched to a cohort of 36 patients who underwent primary unilateral THA for osteoarthritis. Study results indicate that THA for failed ORIF of the hip is a successful procedure despite concerns of increased intraoperative difficulty and risk of fracture.     

Total hip arthroplasty for failed treatment of acetabular fractures: a 5-year follow-up study

Total hip arthroplasty (THA) remains an available surgical option for failed treatment of acetabular fractures. We retrospectively analyzed 53 patients who underwent THA because of failed treatment of acetabular fractures. The mean duration of follow-up monitoring was 64 months (range, 32-123 months) in 49 patients. The average Harris hip score increased from 49.5 before surgery to 90.1 at the latest follow-up examination. Postoperative complications included 1 dislocation, 3 sciatic nerve injuries, and 3 class III instances of heterotopic ossification. There was only 1 revision due to aseptic loosening of the acetabular and femoral component. Despite the technically demanding nature of the procedure, the results of acetabular reconstruction are encouraging in these patients; complication rates are low, and patient satisfaction level is high.     

Anterior Knee Pain After Total Hip Arthroplasty in Developmental Dysplasia

Little has been reported on knee pain after total hip arthroplasty (THA). The purpose of this study was to investigate the incidence and mechanism of knee pain after THA. Two hundred fifty-two patients with hip dysplasia were clinically and radiographically assessed for knee pain before and after THA. Incidences of knee pain and patellofemoral alignment were analyzed with reference to postoperative change in leg length, femoral anteversion, and the femoral offset. Anterior knee pain was present in 16 patients (7.3%). Lateral patellar tilt was increased in all patients with knee pain and significantly larger compared to that seen in patients without knee pain. The increased patellar tilt disappeared within 3 months, but symptoms in 4 patients persisted for more than 3 months. The patellar tilt was significantly related to the amount of leg lengthening. This study demonstrates that THA influences the patellofemoral joint via leg lengthening and causes anterior knee pain.     

Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

Background:

Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures.

Materials and Methods:

A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures.

Results:

The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients (n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore''s prosthesis (n=1), Charnley''s prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found (P < 0.0001). None of the patients had recurrence of infection.

Conclusions:

The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.     

Results of total hip arthroplasty for dialysis arthropathy in long-term hemodialysis patients

Background  The number of hemodialysis patients has progressively increased in Japan. Among the orthopedic complications in this population, chronic hip arthropathy associated with long-term hemodialysis is one of the most devastating problems. Total hip arthroplasty (THA) is often indicated. However, varying results have been reported for THA in these patients. This study was undertaken to assess the risk-benefit ratio of THA performed in patients with dialysis hip arthropathy. Methods  We evaluated 17 patients (19 hips) with dialysis hip arthropathy who underwent THA. The duration of hemodialysis before surgery ranged from 10 to 27 years. Histological examination of the tissue samples revealed accumulation of amyloid deposits in all cases. Three patients died within 2 years after operation; the remaining 14 patients (16 hips) were followed for a minimum of 3 years. Results  The cumulative survival rate of the prostheses in these 16 hips up to the latest follow-up was 94%. Regarding surgery-related complications, deep infection occurred in one hip, and revision THA was required in one patient with recurrent dislocation and aseptic loosening. Conclusions  THA for dialysis hip arthropathy in long-term hemodialysis patients is associated with substantial local and general risks. Despite the substantial risk, THA for this patient population seems to afford reasonably satisfactory results.     

Total hip arthroplasty for failed aseptic Austin Moore prosthesis

Background:

Though Austin Moore (AM) replacement prosthesis has fairly good short term results for intracapsular femoral neck fractures in the elderly, it still is a compromised option and has a high failure rate in the long run. The objective of the present retrospective study is to analyze the functional outcome, assess survivorship of revision total hip arthroplasty (THA) at mid to long term followup, and evaluate intraoperative difficulties faced during conversion of failed aseptic AM prosthesis to cemented THA.

Materials and Methods:

Eighty-nine cemented THA surgeries for failed AM prosthesis were performed between 1986 and 2005. AM failures were classified into seven groups on the basis of mode of failure. Infected failures were excluded from the study. There were 35 men and 54 women in the study group. The mean age was 68 years (range 57–91 years). Mean followup was 8 years (range 5–13 years).

Results:

Average Harris Hip Score improved from 65 preoperatively (range 42–73) to 87 (range 76–90) at 1 year postoperatively and to 86 (range 75–89) at the last followup. The overall complication rate was 4.5%.

Conclusion:

Conversion THA is an excellent treatment strategy for symptomatic failed AM hemiarthroplasty in terms of pain relief and restoration of function and mobility as near as possible to the preinjury level. Also, hemiarthroplasty should not be used in physically active patients, even in elderly individuals. Careful patient selection for hemiarthroplasty versus THA is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.     

Conversion Total Hip Arthroplasty After Previous Transtrochanteric Rotational Osteotomy for Osteonecrosis of the Femoral Head

The results of conversion total hip arthroplasty (THA) after failed transtrochanteric rotational osteotomy (TRO) are still controversial. We retrospectively reviewed 18 patients with ONFHs who had been treated previously by TRO and were later converted to THAs (conversion group). We made a matched control group of 18 primary THAs for ONFH done by same hip surgeon (PTHA group). There was an improvement in the Harris hip score and WOMAC score at the final follow-up but the improvement was not statistically significant between the two groups. Only internal rotation was significantly better in the PTHA group than in the conversion group. THA after TRO provides satisfactory clinical and radiological outcomes with no significant increase in perioperative morbidity in comparison with that in the primary THA.