Mohaddes Maziar, Cnudde Peter, Rolfson Ola, Wall Alexander, Kärrholm Johan
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Swedish Hip Arthroplasty Register, Registercentrum VGR, SE-413 45, Göteborg, Sweden.
Int Orthop. 2017 Mar;41(3):583-588. doi: 10.1007/s00264-016-3381-2. Epub 2017 Jan 11.
Dislocation after total hip arthroplasty (THA) is a common reason for revision. The last decade fostered a significant increase in the use of dual-mobility cups (DMCs). Here we report our study on the short-term survival rate of a cemented DMC reported to the Swedish Hip Arthroplasty Register (SHAR) compared with other cemented designs used in first-time revision due to dislocation.
During 2005-2015, 984 first-time revisions for dislocation were reported to SHAR. In 436 of these cases a cemented dual articular cup was used. During the same time period, 355 revisions performed with a standard cemented cup (femoral head size 28-36 mm) were reported to the SHAR. Patients receiving a DMC were slightly older (75 years, p = 0.005). Re-revision for all reasons was used as primary endpoint. We also anlaysed risk for re-revision of the acetabular component and re-revision due to dislocation. Kaplan-Meier implant survival and a Cox regression analyses adjusted for age and gender were performed.
Implant survival at 4 years for all reasons (91% ± 3.7% vs 86% ± 4.1%, p = 0.02), and especially for re-operation because of dislocation, favours the DMC group (96% ± 3.0% vs 92% ± 3.3%, p = 0.001).
Our findings indicate that use of a cemented DMC reduces the short- to mid-term risk of a second revision in first-time revisions compared with classic cup designs. Longer follow-up is needed to establish any long-term clinical advantages when DMCs are used in revisions performed due to dislocation.
全髋关节置换术（THA）后脱位是翻修的常见原因。在过去十年中，双动髋臼杯（DMC）的使用显著增加。在此，我们报告了一项关于骨水泥型DMC短期生存率的研究，该研究将其与因脱位进行初次翻修时使用的其他骨水泥型设计进行了比较，并上报至瑞典髋关节置换登记处（SHAR）。
2005年至2015年期间，有984例因脱位进行初次翻修的病例上报至SHAR。其中436例使用了骨水泥型双关节髋臼杯。在同一时期，有355例使用标准骨水泥杯（股骨头尺寸28 - 36毫米）进行翻修的病例上报至SHAR。接受DMC的患者年龄稍大（75岁，p = 0.005）。将所有原因导致的再次翻修作为主要终点。我们还分析了髋臼部件再次翻修的风险以及因脱位导致的再次翻修风险。进行了Kaplan - Meier植入物生存率分析以及针对年龄和性别的Cox回归分析。
所有原因导致的4年植入物生存率方面（91% ± 3.7% 对比 86% ± 4.1%，p = 0.02），尤其是因脱位进行再次手术的情况，DMC组更具优势（96% ± 3.0% 对比 92% ± 3.3%，p = 0.001）。
我们的研究结果表明，与传统髋臼杯设计相比，在初次翻修中使用骨水泥型DMC可降低短期至中期再次翻修的风险。当因脱位进行翻修而使用DMC时，需要更长时间的随访来确定其任何长期临床优势。
