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Z Orthop Unfall 2016; 154(04): 385-391
DOI: 10.1055/s-0042-106977
Aus den Sektionen – AE Deutsche Gesellschaft für Endoprothetik
Georg Thieme Verlag KG Stuttgart · New York

Risiko Hüftluxation – welche Patienten brauchen besondere Maßnahmen?

Risk of Hip Dislocation – which Patients Need Special Treatment?
G. Kath
Centrum für Muskuloskeletale Chirurgie, Orthopädische Universitätsklinik der Charité, Berlin
,
C. Perka
Centrum für Muskuloskeletale Chirurgie, Orthopädische Universitätsklinik der Charité, Berlin
,
K. Thiele
Centrum für Muskuloskeletale Chirurgie, Orthopädische Universitätsklinik der Charité, Berlin
› Author Affiliations
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Publication History

Publication Date:
18 August 2016 (online)

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Zusammenfassung

Einleitung: Die Luxation einer Hüfttotalendoprothese (Hüft-TEP) stellt eine der Hauptkomplikationen nach Primärimplantation und Revisionsintervention dar. Die Definition von operations-, indikations- und patientenspezifischen Risikofaktoren ermöglicht, risikobehaftete Patienten zu erkennen. Ziel: Ziel dieser Arbeit ist es, bekannte patientenspezifische Risikofaktoren, wie Body-Mass-Index (BMI), Alter und Geschlecht, für eine Primärluxation in Bezug auf eine Sekundärluxation zu evaluieren. Hierbei soll der Frage nachgegangen werden, ob ein erhöhter BMI, fortgeschrittenes Alter und weibliches Geschlecht eine Zweitluxation begünstigen. Methode: Zur Identifikation von Risikofaktoren für ein Luxationsereignis nach Hüft-TEP erfolgte die retrospektive Auswertung aller Erst- bzw. Rezidivluxationen, welche zwischen 2007 und 2011 in unserer Klinik behandelt wurden. 106 Patienten ohne Indikation zur Wechseloperation nach erfolgter Primärluxation wurden eingeschlossen und primär konservativ behandelt. Die Kohorte wurde in Abhängigkeit des Therapieerfolgs in 2 Gruppen unterteilt und die patientenspezifischen Risikofaktoren (BMI, Alter, Geschlecht) analysiert. Gruppe I (n = 32) beinhaltet die Patienten ohne Reluxationsereignis nach der primären Luxation, während in Gruppe II (n = 74) Patienten mit Reluxationsereignis eingeschlossen wurden. Ergebnisse: Das durchschnittliche Alter zum Zeitpunkt der Erstluxation betrug 68 ± 14 Jahre (32 % Männer und 68 % Frauen). Eine Reluxation trat in 74 (70 %) Fällen auf. Bei der Betrachtung des BMI wies die Gruppe II einen signifikant höheren BMI (27,11 ± 6,24 kg/m2) auf im Vergleich zur Gruppe I (24,49 ± 4,86 kg/m2; p = 0,02). Ein signifikanter Einfluss des Alters konnte nicht nachgewiesen werden (p = 0,70). In der Gruppe I wurde ein durchschnittliches Alter von 71 ± 16 Jahren und in der Gruppe II von 70 ± 13 Jahren errechnet. Dagegen fand sich ein 2,33-fach höheres Vorkommen einer Primär- und Rezidivluxation bei Frauen gegenüber Männern. Ein höheres Risiko für eine Rezidivluxation bei Frauen fand sich jedoch nicht (p = 0,43). Zusammenfassung: Ein erhöhter Body-Mass-Index geht mit einer signifikanten Erhöhung des Risikos einer Rezidivluxation einher. Alter und Geschlecht beeinflussen das Risiko für eine Zweitluxation jedoch nicht. Die Hüftgelenksluxation ist jedoch ein multifaktorielles Ereignis, das neben patientenspezifischen Faktoren auch durch indikations- und operationsspezifische Parameter bestimmt wird.

Abstract

Introduction: Dislocation of a hip arthroplasty is one of the main complications after primary or revision surgery. Definition of specific risk factors concerning patient, indication and surgery makes it possible to determine risk patients for dislocation. Aim: The aim of this study is to identify patient-specific risk factors, such as body mass index (BMI), age and gender, in order to evaluate primary dislocation and to correlate with secondary dislocation. It is investigated whether high BMI, advanced age or female gender are able to promote secondary dislocation. Method: In order to identify risk factors for dislocation after primary and revision hip arthroplasty, a retrospective analysis for dislocation was performed of all hip arthroplasties treated in our hospital between 2007 and 2011. 106 patients without an indication for surgical revision were included and treated conservatively. The patient cohort was divided into two groups, depending on the success of the therapy and were analysed for BMI, age and gender. Group I (n = 32) included patients without a re-dislocation event, in contrast to group II (n = 74), which included patients with re-dislocation of the hip arthroplasty. Results: The mean age at the time of primary dislocation was 68 ± 14 years (32 % male and 68 % female). Re-dislocation was presented in 74 cases (70 %). Group II showed a significantly higher BMI (27.11 ± 6.24 kg/m2) than group I (24.49 ± 4.86 kg/m2; p = 0.02). There was no significant effect of age (p = 0.70). The mean age in group I was 71 ± 16 years and in group II of 70 ± 13 years. The incidence of hip dislocation was 2.33-fold higher in women than in men. There was no significant difference between the genders with respect to the risk of re-dislocation. Summary: A higher BMI correlates significantly with a greater risk of re-dislocation of a hip arthroplasty. On the other hand, age and gender do not influence the risk. However, the dislocation of a hip arthroplasty is a multifactorial event, which can be influenced by patient-specific factors as well as specific factors for indication and operation technique.

Schlüsselwörter

Hüft-TEP-Luxation - Risikofaktoren - Hüftendoprothese

Key words

revision hip dislocation - risk factors - hip arthroplasty - revision
 

  • Literatur

  • 1 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370: 1508-1519
    CrossrefPubMedSearch in Google Scholar
  • 2 Garellick G, Kärrholm J, Lindahl H et al. Swedish Hip Arthroplasty Register – Annual Report 2013. 2013
    PubMedSearch in Google Scholar
  • 3 Sadoghi P, Liebensteiner M, Agreiter M et al. Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty 2013; 28: 1329-1332
    CrossrefPubMedSearch in Google Scholar
  • 4 Overgaard S. Danish Hip Arthroplasty Register; 2011.
    PubMed
  • 5 Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am 2002; 84-A: 1788-1792
    PubMedSearch in Google Scholar
  • 6 Bozic KJ, Kurtz SM, Lau E et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91: 128-133
    CrossrefPubMedSearch in Google Scholar
  • 7 Khatod M, Barber T, Paxton E et al. An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res 2006; 447: 19-23
    CrossrefPubMedSearch in Google Scholar
  • 8 Barrack RL, Butler RA, Laster DR et al. Stem design and dislocation after revision total hip arthroplasty: clinical results and computer modeling. J Arthroplasty 2001; 16: 8-12
    CrossrefPubMedSearch in Google Scholar
  • 9 Berry DJ, von Knoch M, Schleck CD et al. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 2005; 87: 2456-2463
    CrossrefPubMedSearch in Google Scholar
  • 10 Hailer NP, Weiss RJ, Stark A et al. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis. An analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop 2012; 83: 442-448
    CrossrefPubMedSearch in Google Scholar
  • 11 Robbins GM, Masri BA, Garbuz DS et al. Treatment of hip instability. Orthop Clin North Am 2001; 32: 593-610
    CrossrefPubMedSearch in Google Scholar
  • 12 Berend KR, Lombardi jr. AV, Mallory TH et al. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplasty 2005; 20: 93-102
    CrossrefPubMedSearch in Google Scholar
  • 13 Leichtle UG, Leichtle CI, Taslaci F et al. Dislocation after total hip arthroplasty: risk factors and treatment options. Acta Orthop Traumatol Turc 2013; 47: 96-103
    CrossrefPubMedSearch in Google Scholar
  • 14 von Knoch M, Berry DJ, Harmsen WS et al. Late dislocation after total hip arthroplasty. J Bone Joint Surg Am 2002; 84-A: 1949-1953
    PubMedSearch in Google Scholar
  • 15 McGrory BJ, Morrey BF, Cahalan TD et al. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br 1995; 77: 865-869
    PubMedSearch in Google Scholar
  • 16 Beaulé PE, Schmalzried TP, Udomkiat P et al. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am 2002; 84-A: 256-263
    PubMedSearch in Google Scholar
  • 17 Bartz RL, Nobel PC, Kadakia NR et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg Am 2000; 82: 1300-1307
    CrossrefPubMedSearch in Google Scholar
  • 18 Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am 2007; 89: 1832-1842
    CrossrefPubMedSearch in Google Scholar
  • 19 Claes L, Kirschner P, Perka C, Rudert M Hrsg. AE-Manual der Endoprothetik. Heidelberg, London, New York: Springer; 2012: 599
    CrossrefSearch in Google Scholar
  • 20 Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 2002; 17: 282-288
    CrossrefPubMedSearch in Google Scholar
  • 21 Preininger B, Haschke F, Perka C. [Diagnostics and therapy of luxation after total hip arthroplasty]. Orthopade 2014; 43: 54-63
    CrossrefPubMedSearch in Google Scholar
  • 22 Haverkamp D, Klinkenbijl MN, Somford MP et al. Obesity in total hip arthroplasty–does it really matter? A meta-analysis. Acta Orthop 2011; 82: 417-422
    CrossrefPubMedSearch in Google Scholar
  • 23 Lübbeke A, Stern R, Garavaglia G et al. Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 2007; 57: 327-334
    CrossrefPubMedSearch in Google Scholar
  • 24 Kim Y, Morshed S, Joseph T et al. Clinical impact of obesity on stability following revision total hip arthroplasty. Clin Orthop Relat Res 2006; 453: 142-146
    CrossrefPubMedSearch in Google Scholar
  • 25 DʼAngelo F, Murena L, Zatti G et al. The unstable total hip replacement. Indian J Orthop 2008; 42: 252-259
    CrossrefPubMedSearch in Google Scholar
  • 26 Itokawa T, Nakashima Y, Yamamoto T et al. Late dislocation is associated with recurrence after total hip arthroplasty. Int Orthop 2013; 37: 1457-1463
    CrossrefPubMedSearch in Google Scholar
  • 27 Jørgensen CC, Kjaersgaard-Andersen P, Solgaard S et al. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Arch Orthop Trauma Surg 2014; 134: 1615-1622
    CrossrefPubMedSearch in Google Scholar
  • 28 Berry DJ, von Knoch M, Schleck CD et al. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 2004; 86-A: 9-14
    PubMedSearch in Google Scholar
  • 29 Byström S, Espehaug B, Furnes O et al. Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 2003; 74: 514-524
    CrossrefPubMedSearch in Google Scholar
  • 30 Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am 1982; 64: 1295-1306
    CrossrefPubMedSearch in Google Scholar
  • 31 Turner RS. Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management. Clin Orthop Relat Res 1994; 301: 196-204
    PubMedSearch in Google Scholar
  • 32 Wetters NG, Murray TG, Moric M et al. Risk factors for dislocation after revision total hip arthroplasty. Clin Orthop Relat Res 2013; 471: 410-416
    CrossrefPubMedSearch in Google Scholar
  • 33 Esposito CI, Gladnick BP, Lee YY et al. Cup position alone does not predict risk of dislocation after hip arthroplasty. J Arthroplasty 2015; 30: 109-113
    CrossrefPubMedSearch in Google Scholar
  • 34 Siavashi B, Mohseni N, Zehtab MJ et al. Clinical outcomes of total hip arthroplasty in patients with ankylosed hip. Arch Bone Jt Surg 2014; 2: 25-30
    PubMedSearch in Google Scholar
  • 35 Werner BC, Brown TE. Instability after total hip arthroplasty. World J Orthop 2012; 3: 122-130
    CrossrefPubMedSearch in Google Scholar
  • 36 Woolson ST, Rahimtoola ZO. Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty 1999; 14: 662-668
    CrossrefPubMedSearch in Google Scholar
  • 37 Conroy JL, Whitehouse SL, Graves SE et al. Risk factors for revision for early dislocation in total hip arthroplasty. J Arthroplasty 2008; 23: 867-872
    CrossrefPubMedSearch in Google Scholar
  • 38 Wang L, Trousdale RT, Ai S et al. Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip. J Arthroplasty 2012; 27: 764-769
    CrossrefPubMedSearch in Google Scholar
  • 39 Lewinnek GE, Lewis JL, Tarr R et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60: 217-220
    PubMedSearch in Google Scholar
  • 40 Abdel MP, von Roth P, Jennings MT et al. What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. Clin Orthop Relat Res 2015; 474: 386-391
    PubMedSearch in Google Scholar
  • 41 Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty 2006; 21: 696-701
    CrossrefPubMedSearch in Google Scholar
  • 42 Amstutz HC, Le Duff MJ, Beaulé PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res 2004; 429: 108-116
    CrossrefPubMedSearch in Google Scholar
  • 43 Hummel MT, Malkani AL, Yakkanti MR et al. Decreased dislocation after revision total hip arthroplasty using larger femoral head size and posterior capsular repair. J Arthroplasty 2009; 24: 73-76
    CrossrefPubMedSearch in Google Scholar
  • 44 Elson LC, Barr CJ, Chandran SE et al. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?. J Arthroplasty 2013; 28: 41-44
    CrossrefPubMedSearch in Google Scholar