Harwin Steven F, Sodhi Nipun, Ehiorobo Joseph, Khlopas Anton, Sultan Assem A, Mont Michael
Knee Arthoplasty, Department of Orthopaedic Surgery, Mount Sinai West, New York, New York.
Department of Orthopaedic Surgery, Lenox Hill Hospital Northwell Health, New York, New York.
Surg Technol Int. 2019 May 15;34:367-370.
Instability can account for over 20% of all revision total hip arthroplasties (THAs). Although a number of surgical techniques have been developed to limit the number of dislocations, prevention still remains a challenge. More recently, dual mobility (DM) cups have been developed to potentially target this problem. Although this implant design has been shown to have a number of potential advantages in the revision setting, there is limited data in the literature on the use of modular dual mobility (MDM) implants for primary THAs. Therefore, the purpose of this study was to evaluate cup survivorships, patient satisfaction outcomes, and complications of this device used for primary THA.
A total of 143 consecutive hips (131 patients) who underwent primary THA using DM prostheses by a high-volume academic surgeon were longitudinally followed up for a minimum of five years (mean: 6 years, 11 months; range, 6 years 3 months to 7 years 5 months). There were 77 women (54%) and 66 men (44%) who had a mean age 65 years (range, 34 to 90 years; SD, 11 years), and the mean body mass index (BMI) was 32 kg/m2 (range, 22 to 52; SD, 8 kg/m2). Patient demographics, (gender, BMI), as well as clinical outcomes were analyzed. Kaplan-Meier analysis was performed to determine aseptic, septic, and all-cause cup survivorship. Additionally, clinical outcomes based on Harris Hip Scores (HHS) and other modalities, as well as complications, were tabulated. Institutional review board (IRB) approval was received prior to initiating this study.
Septic survivorship was found to be 99.3% (95% CI: 0.98 to 1.0), while all-cause survivorship was 98.6% (95% CI: 0.97 to 1.0). There were a total of two revision surgeries; however, these were not related to the MDM cup. Specifically, one patient had femoral stem loosening, while another patient had a late deep infection treated with a two-stage procedure. At most recent follow up, both patients were progressing well and had HHS scores of 85 and 92 points. The mean total HHS score was 95 points (range, 64 to 100) at most recent follow up. Other complications affecting patient outcomes included two patients who presented with concerns for deep vein thrombi, which were both medically managed, as well as one patient who had a non-fatal pulmonary embolism, which was also medically managed. The final HHS scores for these three patients were 83, 100, and 96 points.
DM cups were designed with the intent of reducing hip instability. Most studies on these cups have reported on revision THA, where the problem of instability may be more paramount; however, fewer studies have reported on the use of this cup for primary THA. The findings from this study indicate excellent survivorship and overall clinical and patient satisfaction results using this construct. These five-year results are very encouraging and hopefully will portend excellent further survivorship with longer follow up.
不稳定因素在所有髋关节置换翻修手术（THA）中占比超过20%。尽管已经研发出多种手术技术来减少脱位的数量，但预防仍然是一项挑战。最近，双动（DM）髋臼杯被研发出来，有望解决这一问题。尽管这种植入物设计在翻修手术中已显示出许多潜在优势，但关于模块化双动（MDM）植入物用于初次全髋关节置换术的文献数据有限。因此，本研究的目的是评估用于初次全髋关节置换术的该装置的髋臼杯生存率、患者满意度结果及并发症情况。
由一位高手术量的学术外科医生为143例连续的髋关节（131例患者）进行了使用DM假体的初次全髋关节置换术，并对其进行了至少五年的纵向随访（平均：6年11个月；范围，6年3个月至7年5个月）。其中有77名女性（54%）和66名男性（44%），平均年龄65岁（范围，34至90岁；标准差，11岁），平均体重指数（BMI）为32kg/m²（范围，22至52；标准差，8kg/m²）。分析了患者的人口统计学特征（性别、BMI）以及临床结果。采用Kaplan-Meier分析来确定无菌性、感染性及全因髋臼杯生存率。此外，还列出了基于Harris髋关节评分（HHS）和其他指标的临床结果以及并发症情况。在开展本研究之前获得了机构审查委员会（IRB）的批准。
感染性生存率为99.3%（95%可信区间：0.98至1.0），而全因生存率为98.6%（95%可信区间：0.97至1.0）。总共进行了两次翻修手术；然而，这些与MDM髋臼杯无关。具体而言，一名患者出现股骨柄松动，另一名患者发生晚期深部感染，接受了两阶段手术治疗。在最近一次随访时，两名患者情况进展良好，HHS评分分别为85分和92分。在最近一次随访时，平均总HHS评分为95分（范围，64至100）。影响患者结果的其他并发症包括两名患者出现深静脉血栓问题，均接受了药物治疗，以及一名患者发生非致命性肺栓塞，也接受了药物治疗。这三名患者的最终HHS评分分别为83分、100分和96分。
DM髋臼杯的设计目的是减少髋关节不稳定。关于这些髋臼杯的大多数研究报告的是髋关节置换翻修手术，在该手术中不稳定问题可能更为突出；然而，较少有研究报告该髋臼杯用于初次全髋关节置换术的情况。本研究结果表明，使用该结构的髋臼杯具有出色的生存率以及总体临床和患者满意度结果。这些五年期结果非常令人鼓舞，有望预示着更长随访期内出色的进一步生存率。
