Vasukutty N L, Middleton R G, Young P, Uzoigwe C, Barkham B, Yusoff S, Minhas T H A
Pilgrim Hospital, Boston, Lincolnshire NHS Trust, UK.
Ann R Coll Surg Engl. 2014 Nov;96(8):597-601. doi: 10.1308/003588414X14055925058391.
Dislocation following total hip replacement continues to be a problem for which no completely satisfactory solution has been found. Several methods have been proposed to reduce the incidence of hip dislocations with varying degrees of success, including elevated rim liners, constrained liners and large diameter bearings. We present our experience with the double mobility acetabular component in patients at high risk of instability.
This was a retrospective review of 65 primary total hip arthroplasties in 55 patients (15 men, 40 women), performed between October 2005 and November 2009. The majority (80%) of patients had at least two and 26% had at least three risk factors for instability. The mean age was 76 years (range: 44-92 years). The patients were followed up for a mean duration of 60 months (range: 36-85 months).
Fourteen patients died and one was lost to follow-up, leaving fifty hips for final assessment. Until the final follow-up appointment, no patients had dislocation and none required revision surgery. The mean Oxford hip score improved from 45.0 to 26.5 (p<0.0001). The mean Merle d'Aubigné pain score improved from 1.4 to 4.9 (p<0.0001), the walking score from 2.3 to 3.1 (p<0.07) and the absolute hip function score from 5.4 to 10.8 (p<0.0001). There were no clinical or radiographic signs of loosening.
The double mobility acetabular component was successful at preventing dislocation during early to medium-term follow-up. However, as data are still lacking with regard to polyethylene wear rates at the additional bearing surface, it would be prudent to restrict the use of this implant to selected patients at high risk of instability.
全髋关节置换术后脱位仍然是一个尚未找到完全令人满意解决方案的问题。已经提出了几种方法来降低髋关节脱位的发生率，取得了不同程度的成功，包括高边髋臼衬垫、限制性衬垫和大直径轴承。我们介绍了我们在使用双动髋臼组件治疗不稳定高危患者方面的经验。
这是一项对2005年10月至2009年11月期间55例患者（15例男性，40例女性）进行的65例初次全髋关节置换术的回顾性研究。大多数（80%）患者至少有两个不稳定危险因素，26%患者至少有三个危险因素。平均年龄为76岁（范围：44 - 92岁）。患者平均随访60个月（范围：36 - 85个月）。
14例患者死亡，1例失访，最终评估50例髋关节。直到最后一次随访预约时，没有患者发生脱位，也没有人需要翻修手术。牛津髋关节平均评分从45.0提高到26.5（p<0.0001）。Merle d'Aubigné平均疼痛评分从1.4提高到4.9（p<0.0001），步行评分从2.3提高到3.1（p<0.07），绝对髋关节功能评分从5.4提高到10.8（p<0.0001）。没有临床或影像学松动迹象。
双动髋臼组件在早期至中期随访期间成功预防了脱位。然而，由于关于额外承重表面的聚乙烯磨损率的数据仍然缺乏，将这种植入物的使用限制于选定的不稳定高危患者是谨慎的做法。
