First Orthopaedic Clinic, Department of Special Surgical Science, University of Florence, CTO-Largo Palagi 1, 50139 Florence, Italy.
Clin Orthop Relat Res. 2012 Dec;470(12):3542-8. doi: 10.1007/s11999-012-2428-y. Epub 2012 Jun 15.
Isolated acetabular revisions using standard cups are at risk of dislocation. The introduction of a nonconstrained dual-mobility cup was designed to improve prosthetic stability without increasing loosening rates, but it is unclear whether the risk of dislocation is reduced.
QUESTIONS/PURPOSES: We therefore determined: (1) if the rate of dislocation in isolated acetabular revisions is lower with a dual-mobility cup, (2) implant survival, (3) patient function, and (4) radiographic incidence of migration, loosening, and osteolysis.
We prospectively followed 33 selected patients who underwent isolated acetabular revisions with a minimum of 2 years' followup (mean, 3 years; range, 2-5 years). In 24 patients a stainless steel dual-mobility cup was cemented into an antiprotrusio cage, whereas in nine we used a hyaluronan dual-mobility revision cup with a foramen hook and superior and posterior flanges screw fixations. We determined Harris hip (HHS) and WOMAC scores and examined radiographs for migration, loosening, and osteolysis.
There were no dislocations. Survivorship rates of the femoral and acetabular components were 97% at 5 years; the rerevision rate for any reason was 3%. At last followup, the mean HHS increased from 48 points preoperatively to 86 points. No patients had progressive osteolysis, component migration, or loosening on radiographs.
In this select group of isolated acetabular revisions, our data suggest the use of a dual-mobility cup reduced the risk of dislocation without increasing loosening from 2 to 5 years.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
使用标准髋臼杯进行孤立性髋臼翻修存在脱位风险。引入非约束性双动杯旨在提高假体稳定性，而不增加松动率，但脱位风险是否降低尚不清楚。
问题/目的：因此，我们确定：（1）双动杯是否降低孤立性髋臼翻修的脱位率，（2）植入物存活率，（3）患者功能，（4）影像学上的迁移、松动和骨溶解发生率。
我们前瞻性随访了 33 例接受孤立性髋臼翻修的患者，随访时间至少 2 年（平均 3 年；范围 2-5 年）。24 例患者采用不锈钢双动杯固定于防旋笼中，9 例患者采用含透明质酸的双动翻修杯，带孔钩和上后缘翼螺钉固定。我们测定了髋关节 Harris（HHS）和 WOMAC 评分，并对影像学检查进行了迁移、松动和骨溶解评估。
无脱位。5 年时股骨和髋臼组件的存活率为 97%；任何原因的再翻修率为 3%。末次随访时，HHS 平均从术前的 48 分增加到 86 分。无患者出现进展性骨溶解、组件迁移或影像学上的松动。
在这组精选的孤立性髋臼翻修患者中，我们的数据表明，双动杯的使用降低了脱位风险，从 2 年到 5 年的松动率没有增加。
IV 级，治疗性研究。详见作者指南，获取完整的证据水平描述。
