Orthopaedic Surgery and Sports Traumatology Academic Clinic, Grenoble Teaching Medical Center, South Hospital, 38130 Échirolles, France.
Orthop Traumatol Surg Res. 2011 Feb;97(1):2-7. doi: 10.1016/j.otsr.2010.07.008. Epub 2010 Dec 21.
Dislocation is a frequent complication of total hip arthroplasties (THA) especially in older patients, especially when using a posterior approach. In these cases, dual mobility (DM) cups developed by Gilles Bousquet in 1975 can be indicated to reduce this complication risk.
Dual mobility cups reduce the rate of dislocation in primary total hip arthroplasty using posterior approach in a single-surgeon series.
Test this hypothesis in a controlled study to compare the rate of dislocation in primary total hip arthroplasties done in patients over 50 years old either with a dual mobility cup or a conventional metal-on-polyethylene 28-mm diameter head.
Two consecutive series of primary total hip replacements were performed by a single surgeon using a posterolateral approach. The piriformis tendon was left intact. The DM series included 105 patients who underwent arthroplasty between January 2005 and June 2007 with a dual mobility cup (60 women and 45 men, mean age 76.6±5.65 years old [53-93]). The control series (S series) included 108 patients who underwent arthroplasty (56 women and 52 men, mean age 74.2±5.9 years old [53-87]) with a conventional 28-mm polyethylene cup between January 2003 and June 2005. All hip replacements included a 28-mm metal-polyethylene cup and a 12-14-mm Morse taper. Both groups were comparable for gender, diagnosis, body mass index, type of anesthesia and ASA score distribution. All patients included in this series had a minimum follow-up of 1 year.
There were no dislocations in the DM series and five early dislocations (before the third month) in the S series for a rate of 4.63%. Although the rate of dislocation was higher in the S series (4.63% vs 0%), the difference was barely significant (P=0.0597).
This study comparing the incidence of dislocations after THA with conventional or dual mobility cups, shows that even using a posterior approach and in older patients, dual mobility cups increase stability with no postoperative dislocations. Although results are barely significant, a larger series should confirm the benefit of this implant. In this series, morbidity was not increased with dual mobility cups.
Level III: retrospective case-control study.
髋关节置换术后脱位是一种常见的并发症，尤其是在老年患者中，尤其是当使用后外侧入路时。在这些情况下，Gilles Bousquet 于 1975 年开发的双动（DM）杯可以用来降低这种并发症的风险。
在后外侧入路的单外科医生系列中，双动杯可降低初次全髋关节置换术后脱位的发生率。
在一项对照研究中验证这一假设，比较使用后外侧入路对 50 岁以上患者进行初次全髋关节置换术时，使用双动杯或传统的金属对聚乙烯 28mm 直径头的脱位率。
一位外科医生连续进行了两批原发性全髋关节置换术，均采用后外侧入路。梨状肌腱保留完整。DM 系列包括 105 例患者，于 2005 年 1 月至 2007 年 6 月期间接受了双动杯治疗（60 名女性和 45 名男性，平均年龄 76.6±5.65 岁[53-93]）。对照组（S 组）包括 108 例患者（56 名女性和 52 名男性，平均年龄 74.2±5.9 岁[53-87]），于 2003 年 1 月至 2005 年 6 月期间接受了传统的 28mm 聚乙烯杯治疗。所有髋关节置换术均包括 28mm 金属聚乙烯杯和 12-14mm Morse 锥度。两组在性别、诊断、体重指数、麻醉类型和 ASA 评分分布方面均具有可比性。本系列所有患者的随访时间均至少为 1 年。
DM 组无脱位，S 组有 5 例早期脱位（在第 3 个月前），脱位率为 4.63%。尽管 S 组的脱位率较高（4.63%比 0%），但差异几乎无统计学意义（P=0.0597）。
本研究比较了使用传统或双动杯治疗 THA 后脱位的发生率，表明即使采用后外侧入路，在老年患者中，双动杯也能增加稳定性，术后无脱位。尽管结果几乎无统计学意义，但更大的系列研究应能证实该植入物的益处。在本系列中，双动杯并没有增加发病率。
三级：回顾性病例对照研究。
