Total kalça protezi ameliyatı sonrası çıkıklarda risk faktörleri ve tedavi seçenekleri

Öz

Amaç: Bu çalışmada primer ve revizyon total kalça protezi (TKP) sonrası ilk çıkık ve tekrarlayan çıkık olgularındaki risk faktörlerini değerlendirmek ve uygun tedavi yaklaşımını belirlemek amaçlandı. Çalışma planı: Çalışmaya 1984-2005 yılları arasında TKP yapılmış (n=5.205) ve sonrasında kalça çıkığı görülen 56 hasta ve bu grupla eşleştirilen 55 hastalık bir kontrol grubu dahil edildi. Her iki grubun hastane çizelgeleri ve radyografileri incelendi. Çalışma grubundan 31 hasta klinik ve radyolojik olarak takip edildi. Bulgular: Primer TKP sonrası çıkık görülme oranı %1.1 (56/5,205) iken, bu hastaların %39’u gibi yüksek bir oranda da tekrarlayan çıkık gözlendi. Ameliyatla ilk çıkık arasında geçen süre ile, ilk çıkık ile çıkığın tekrarlaması arasında geçen süre arasında pozitif bir korelasyon saptandı (r=0.4). Primer çıkıkların çoğu ameliyattan kısa bir süre sonra meydana geldiğinden sonraki çıkıklara da zemin hazırlamış oldular. Revizyon artroplastisi ve kadın cinsiyetin çıkık görülme riskini arttırdığı görüldü. Asetabuler kabın oryantasyonu ile çıkık arasında bir ilişki saptanmadı. Çıkarımlar: İlk çıkık sonrası tekrarlayan çıkıkların önlenmesi açısından cerrahi girişim gerektirecek olası teknik sorunların ciddi şekilde değerlendirilmesi gerektiğini düşünüyoruz. Yüksek nüks oranları dikkate alındığında, özellikle ilk TKP çıkığı sonrası sıkı bir konservatif tedavi uygulanmalıdır.

Anahtar Kelimeler

• Çıkık; tedavi; total kalça protezi.

Dislocation after total hip arthroplasty: risk factors and treatment options

Öz

Objective: The aim of this study was to analyze the setting for dislocations and redislocations after primary and revision total hip arthroplasty (THA), identify risk factors and optimize treatment.
Methods: This study included 56 patients with a dislocated hip following THA (n=5,205) between 1984 and 2005 and a matched control group (n=55). Hospital charts and radiographs of all patients in both groups were analyzed. Thirty-one patients in the study group were followed both clinically and radiologically.
Results: The dislocation rate after primary THA was 1.1% (56/5,205) and the redislocation rate after a first occurrence was as high as 39%. There was a positive correlation between the time intervals from the surgery to first dislocation and from the first dislocation to second dislocation (r=0.4). Most of the primary dislocations occurred within a short period of time after surgery, thus favoring consecutive dislocations. Female gender, as well as revision arthroplasty, was associated with a higher incidence of dislocations. No relation was found between the orientation of the acetabular cup and dislocation.
Conclusion: To prevent redislocations after the first occurrence, we suggest thorough evaluation of possible technical faults which should be addressed surgically. Considering the high redislocation rate, we also advocate a stringent conservative treatment regime especially after the first THA dislocation.

Anahtar Kelimeler

• Dislocation
• total hip arthroplasty
• treatment

Kaynakça

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