Philippot R, Adam P, Farizon F, Fessy M H, Bousquet G
Service de Chirurgie Orthopédique et Traumatologique, Pavilion 1-3, Hôpital Bellevue, boulevard Pasteur, 42055 Saint-Etienne Cedex 2.
Rev Chir Orthop Reparatrice Appar Mot. 2006 Jun;92(4):326-31. doi: 10.1016/s0035-1040(06)75762-2.
We report a retrospective series of 106 total hip prosthesis with ten years follow-up. The purpose of this study was to analyze survival of cementless dual mobility sockets.
The series included 90 consecutive patients with 106 first-intention total hip prosthesis, all with cementless dual mobility sockets. All prosthesis (Novae-1 socket and Profil-1 stem, Serf) were implanted within a 6-month period. The stainless steal socket was coated with alumina and had two short anchorage studs and a superior mooring screw and a polyethylene retentive liner. The stem had a 22.2 mm chromium cobalt head. The main indication for arthroplasty was degenerative joint disease. Mean age at implantation was 56 years (range 23-87). All patients were seen for physical examination and x-rays every two or three years. We noted cup survival at ten years (actuarial method), defining surgical revision for cup replacement due to an aseptic cause as the endpoint.
Twelve patients died during the 10-year follow-up and one was lost to follow-up. The Postel-Merle d'Aubligné score improved from 7.1 preoperatively to 15.8 at ten years. There were two isolated acetabular loosenings, two intra-prosthetic dislocations due to advanced wear of the polyethylene insert. The overall survival rate of the socket was 94.6% at ten years. There were no episodes of prosthetic instability in this series.
This study demonstrates the good ten-year survival of the dual mobility socket, comparable to that of conventional prostheses. The absence of any case of prosthetic instability in this series confirms the good short-term and long-term stability of the dual mobility socket. Intraprosthetic dislocation, due to loss of the polyethylene retaining ring is the main limitation of this method. The incidence was however low (2% at ten years) and treatment was not a problem. We recommend using the dual-mobility socket as the first-intention implant for patients with a high risk of post-operative instability, but also recommend it for all patients aged over 70 years since instability is the leading cause of surgical revision after this age.
我们报告了一组106例全髋关节置换术的回顾性研究，随访时间为10年。本研究的目的是分析非骨水泥双动髋臼杯的生存率。
该系列包括90例连续患者，共106例初次全髋关节置换术，均采用非骨水泥双动髋臼杯。所有假体（Novae - 1髋臼杯和Profil - 1股骨柄，Serf）均在6个月内植入。不锈钢髋臼杯涂有氧化铝，有两个短锚固螺柱、一个上固定螺钉和一个聚乙烯固定衬垫。股骨柄有一个22.2毫米的铬钴头。关节置换术的主要适应证为退行性关节疾病。植入时的平均年龄为56岁（范围23 - 87岁）。每两到三年对所有患者进行体格检查和X线检查。我们采用精算方法记录10年时髋臼杯的生存率，将因无菌性原因进行髋臼杯置换的手术翻修定义为终点。
在10年随访期间，12例患者死亡，1例失访。Postel-Merle d'Aubligné评分从术前的7.1分提高到10年时的15.8分。有2例孤立性髋臼松动，2例因聚乙烯内衬严重磨损导致的假体脱位。髋臼杯10年的总体生存率为94.6%。该系列中无假体不稳定事件发生。
本研究表明双动髋臼杯10年生存率良好，与传统假体相当。该系列中无任何假体不稳定病例证实了双动髋臼杯良好的短期和长期稳定性。由于聚乙烯固定环丢失导致的假体脱位是该方法的主要局限性。然而，其发生率较低（10年时为2%），且治疗并非难题。我们建议将双动髋臼杯作为术后不稳定高危患者的初次植入假体，也建议所有70岁以上患者使用，因为在这个年龄段后，不稳定是手术翻修的主要原因。
