Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center.

Autor: Sarpong NO; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Rodriguez S; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Kuyl EV; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Lyman S; Department of Biostatistics, Hospital for Special Surgery, New York, New York., Della Valle AG; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Vigdorchik JM; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York., Rodriguez JA; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2024 Apr; Vol. 39 (4), pp. 1019-1024.e1. Date of Electronic Publication: 2023 Oct 31.
DOI: 10.1016/j.arth.2023.10.041
Abstrakt: Background: Patients who have spinal stiffness and deformity are at the highest risk for dislocation after total hip arthroplasty (THA). Previous reports of this cohort are limited to antero-lateral and postero-lateral (PL) approaches. We investigated the dislocation rate after direct anterior (DA) and PL approach THA with a contemporary high-risk protocol to optimize stability.
Methods: We investigated patients undergoing THA who had preoperative biplanar imaging from January-December 2019. Patients were identified using radiographic criteria of spinal-stiffness (<10-degree change in sacral slope from standing to seated) and deformity (flatback deformity with >10-degree difference in pelvic incidence and lumbar lordosis). There were 367 patients identified (181 DA, 186 PL). The primary outcome was dislocation rate at 2-years postoperatively. Risk-factors for dislocation were evaluated using logistic regressions (significance level of 0.05).
Results: There were 6 (1.6%) dislocations in the entire cohort, with low dislocation rates for both DA (0.6%) and PL-THA (2.7%). We observed increased utilization of dual mobility with larger outer head bearings (>38 mm) with PL-THA (34.4 versus 5.0%, P < .01) and conversely increased utilization of 32-mm femoral-heads with DA-THA (39.4 versus 7.0%, P < .001). Surgical approach (PL) was not a significant risk-factor for dislocation (odds ratio: 5.03, P = .15). Patients who had a history of lumbar-fusion had 8-times higher odds for dislocation (OR: 8.20, P = .020).
Conclusions: To the best of our knowledge, this is the largest series to date evaluating DA and PL-THA in the hip-spine 2B-group. Our results demonstrate lower dislocation rate than expected with either surgical approach using a high-risk protocol.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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