Kısıtlayıcı asetabular komponent kullanmak kalça eklem hareket açıklığını gerçekten azaltır mı?

Öz

Amaç: Kısıtlayıcı asetabular insertler, instabilitenin cerrahi tedavisinde sıklıkla kullanılmaktadır. Bununla birlikte, gevşeme sıklığını artıracağı ve kalça eklem hareket açıklığını azaltacağı endişesi ile cerrahlar arasında daha az tercih edilmektedir. Bu çalışmanın amacı, kısıtlayıcı asetabular komponent kullanımının kalça eklem hareket açıklığı ve fonksiyonel sonuçlar üzerindeki etkisinin incelenmesidir Gereç ve Yöntemler: Revizyon kalça artroplastisi uygulanan 28 hasta çalışmaya dahil edildi. Hastalar kullanılan insert tipine göre kısıtlayıcı ve kısıtlayıcı olmayan şeklinde iki gruba ayrıldı. Ortalama takip süresi kısıtlayıcı grupta 61±7 (50-74) ay, kısıtlayıcı olmayan grupta 59±7 (50-72) aydı.Kalça eklem hareket açıklıkları ve harris kalça skorları ameliyat öncesi ve sonrası son kontrolde kaydedildi. Bulgular: Ortalama fleksiyon, abdüksiyon, addüksiyon, dış rotasyon ve iç rotasyon değerleri kısıtlayıcı grupta (n=15) sırası ile 78°±15°, 43°±4°, 28°±3°, 30°±7°,19°±8° iken, kısıtlayıcı olmayan grupta (n=13) 75°±14°, 40°±6°, 26°±5°, 30°±12°, 17°±6° idi. Gruplar arasındaki fark istatistiksel olarak anlamlı değildi (p>0.05). Harris kalça skorları her iki grupta da ameliyat öncesine göre anlamlı artış gösterdi, gruplar arasında anlamlı farklılık yoktu (p>0.05). Sonuç: Bu çalışmanın bulguları, kısıtlayıcı asetabular insert kullanılan hastalardaki kalça eklem hareket açıklıkları ve fonksiyonel sonuçların, orta dönemde, kısıtlayıcı olmayanlara göre daha az olmadığını göstermiştir.

Anahtar Kelimeler

• eklem hareket açıklığı
• total kalça artroplastisi
• eklem instabilitesi

Does using constrained acetabular component really limit hip range of motion?

Öz

Aim: In surgical treatment of instability, constrained acetabular inserts are frequently used in hip arthroplasty. However the reasons why surgeons avoid constrained acetabular components are the concern of an increased rate of loosening possibly due to impingement and the concern of decreased range of motion. This study aims to investigate the influence of constrained acetabular insert usage on hip range of motions and functional results. Material and Methods: Twenty-eight patients who needed revision hip arthroplasty were included. Patients were divided into two groups according to acetabular insert used in surgery (constrained and non-constrained). Mean follow-up period was 61±7 months (range, 50-74) in constrained group and 59±7 (range, 50-72) in non-constrained group. Hip range of motion and harris hip scores were recorded pre-operatively and at final follow-up. Results: The final avarage flexion, abduction, adduction, external rotation and internal rotation was respectively 78°±15°, 43°±4°, 28°±3°, 30°±7°,19°±8° in constrained group (n=15) and 75°±14°, 40°±6°, 26°±5°, 30°±12°, 17°±6° in non-constrained group (n=13). The difference between groups was not statistically significant. Harris hip score increased in both groups and there was no significant difference between groups (p=0.730). Conclusion: Findings of this mid term study showed that hip range of motions and functional results in patients with constrained acetabular inserts are not inferior than the patients with non-constrained inserts.

Anahtar Kelimeler

• articular range of motion
• total hip arthroplasty
• joint instability

Kaynakça

1. 1. Vikas K. Total Hip Arthroplasty in 2017 – Current Concepts and Recent Advances. Indian J Orthop 2017; 51: 357–58.
2. 2. Karam JA, Tokarski AT, Ciccotti M, et al. Revision total hip arthroplasty in younger patients: indications, reasons for failure, and survivorship. Phys Sportsmed 2012; 40: 96-101.
3. 3. Rogers M, Blom AW, Barnett A, et al. Revision for recurrent dislocation of total hip replacement. Hip Int 2009; 19: 109-13.
4. 4. Springer BD, Fehring TK, Griffin WL, et al. Why Revision Total Hip Arthroplasty Fails. Clin Orthop Relat Res 2009; 467: 166–73.
5. 5. Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles. Instr Course Lect 2009; 58: 183-91.
6. 6. Brian CW, Thomas EB. Instability after total hip arthroplasty. World J Orthop 2012; 3: 122-30.
7. 7. Mohammed R, Hayward K, Mulay S, et al. Outcomes of dual-mobility acetabular cup for instability in primary and revision total hip arthroplasty. J Orthop Traumatol 2015; 16: 9-13.
8. 8. Su EP, Pellicci PM. The role of constrained liners in total hip arthroplasty. Clin Orthop Relat Res 2004; 420: 122-9.

9. 9. Lachiewicz PF, Kelley SS. The use of constrained components in total hip arthroplasty. J Am Acad Orthop Surg 2002; 10: 233-8.
10. 10. Pace T, Finley S, Snider R, et al. Short-term results of novel constrained total hip arthroplasty Orthop Rev (Pavia) 2015; 7: 5779.
11. 11. John TW, Phillip SR, Susannah C. Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop 2007; 31: 273-7.
12. 12. Maximillian S, Harry ER, William M. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg 2004; 12: 314-21.
13. 13. Noble PC, Durrani SK, Usrey MM. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res 2012; 470: 1907-16.
14. 14. Donaldson T, Clarke IC. Successes and failures of a freedom constrained cup used in a major salvage procedure. Reconstructive Review 2017; 7.
15. 15. Nomura T, Naito M, Nakamura Y,  et al. An analysis of the best method for evaluating anteversion of the acetabular component after total hip replacement on plain radiographs. Bone Joint J 2014; 96: 597- 603
16. 16. Shrader MW, Parvizi J, Lewallen DG. The use of a constrained acetabular component to treat instability after total hip arthroplasty. J Bone Joint Surg 2003; 85: 2179-83
17. 17. Karvonen M, Karvonen H, Seppanen M, et al. Freedom constrained liner for the treatment and prevention of dislocation in total hip arthroplasty. Scand J Surg 2017; 106: 165-72.
18. 18. Luigi Z, Roberto GC. Ceramic–ceramic coupling with big heads: clinical outcome. Eur J Orthop Surg Traumatol 2007; 17: 247-51.
19. 19. Hernigou P, Filippini P. Constrained liner in neurologic or cognitively impaired patients undergoing primary THA. Clin Orthop Relat Res 2010; 468: 3255-62.
20. 20. Ewan B, Michael RW, Gordon C. The Medium Term Outcome of the Omnifit constrained acetabular cup. Hip Int 2012; 22: 505-10.
21. 21. Gill K, Whitehouse SL, Hubble Mj, et al. Short-term results with a constrained acetabular liner in patients at high risk of dislocation after primary total hip arthroplasty. Hip Int 2016; 26: 580-84.
22. 22. Rady AE, Asal MK, Bassiony AA. The use of a constrained cementless acetabular component for instability in total hip replacement. Hip Int 2010; 20: 434-9.
23. 23. Lewis PL, Graves SE, de Steiger RN, et al. Constrained Acetabular Components Used in Revision Total Hip Arthroplasty: A Registry Analysis. J Arthroplasty 2017; 32: 3102-07.
24. 24. Berend KR, Lombardi AV Jr, Mallory TH, et al. The long-term outctome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplasty 2005; 20: 93-102.
25. 25. Bremner BR, Goetz DD, Callaghan JJ, et a. Use of constrained acetabular components for hip instability: an average 10-year follow-up study. J Arthroplasty 2003; 18: 131-7.