University of British Columbia, Department of Orthopaedics (Adult Hip and Knee Reconstruction Service), Gordon & Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada.
J Arthroplasty. 2018 Sep;33(9):2961-2966. doi: 10.1016/j.arth.2018.05.005. Epub 2018 May 9.
Instability remains one of the main problems after revision hip surgery. The aim of this study was to review the clinical, radiological, and patient-reported outcomes with the use of modular dual-mobility articulation for revision acetabular reconstruction and investigate the risk of fretting corrosion by measuring serum trace metal ion levels.
Sixty consecutive patients with a minimum of 24-month follow-up after the insertion of a modular dual-mobility (Stryker, Mahwah, NJ) cup at the time of revision hip surgery were identified. Follow-up included clinical and radiological patient review and functional outcome measures, and a subset of patients had their metal ion (cobalt and chromium) levels checked.
At the most recent follow-up, 5 patients had died, 3 patients have been revised because of ongoing instability, and 3 patients have had revision surgery due to infection. Overall functional outcome (mean Western Ontario and McMaster Universities Osteoarthritis Indexfunction 76, University of California, Los Angeles 5.6, mean Oxford 74.7, Short Form-12 physical 41.6/mental 53.3) and overall pain relief (mean Western Ontario and McMaster Universities Osteoarthritis Index pain score 78.3) scores were good. The mean satisfaction score was 78 of 100. The median serum trace metal chromium and cobalt levels at the most recent follow-up were 0.4 µg/L (range 0.1-6.1 µg/L) and 0.42 µg/L (range 0.21-9.42 µg/L), respectively. The survival with revision as the end point was 90%.
Dual-mobility cups with modularity represent an excellent option for the patient having revision hip surgery at high risk of instability. This series presents good patient-reported outcome measures and a low complication and revision rate.
在髋关节翻修手术后，不稳定仍然是主要问题之一。本研究旨在回顾使用模块化双动关节进行髋臼翻修重建的临床、影像学和患者报告结果，并通过测量血清痕量金属离子水平来研究磨损腐蚀的风险。
确定了 60 例在髋关节翻修手术时植入模块化双动（Stryker，Mahwah，NJ）杯的患者，这些患者至少随访 24 个月。随访包括临床和影像学患者评估以及功能结果测量，并且一部分患者检查了金属离子（钴和铬）水平。
在最近的随访中，5 例患者死亡，3 例因持续不稳定而再次手术，3 例因感染而再次手术。总体功能结果（平均 Western Ontario and McMaster Universities Osteoarthritis Index 功能 76 分，University of California，Los Angeles 5.6 分，平均 Oxford 74.7 分，Short Form-12 身体 41.6/精神 53.3 分）和总体疼痛缓解（平均 Western Ontario and McMaster Universities Osteoarthritis Index 疼痛评分 78.3 分）评分良好。平均满意度评分为 78 分（满分 100 分）。最近随访时血清痕量金属铬和钴中位数水平分别为 0.4 µg/L（范围 0.1-6.1 µg/L）和 0.42 µg/L（范围 0.21-9.42 µg/L）。以翻修为终点的生存率为 90%。
对于有高不稳定风险的髋关节翻修手术患者，模块化双动杯是一种出色的选择。本系列提供了良好的患者报告结果，且并发症和翻修率低。
