双动杯：在原发性全髋关节置换术因骨关节炎而翻修的风险中的作用：基于北欧关节置换注册协会数据库的匹配人群研究。
Dual Mobility Cups: Effect on Risk of Revision of Primary Total Hip Arthroplasty Due to Osteoarthritis: A Matched Population-Based Study Using the Nordic Arthroplasty Register Association Database.
机构信息
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, and Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
Department of Orthopaedics, Skåne University Hospital, Lund University, Malmö, Sweden.
出版信息
J Bone Joint Surg Am. 2019 Jan 16;101(2):169-176. doi: 10.2106/JBJS.17.00841.
BACKGROUND
The dual mobility acetabular cup (DMC) was designed to reduce prosthetic instability and has gained popularity for both primary and revision total hip arthroplasty (THA). We compared the risk of revision of primary THA for primary osteoarthritis between patients treated with a DMC and those who received a metal-on-polyethylene (MoP) or ceramic-on-polyethylene (CoP) bearing.
METHODS
A search of the Nordic Arthroplasty Register Association (NARA) database identified THAs performed with a DMC during 1995 to 2013. With use of propensity score matching, 2,277 of these patients were matched (1:1), with regard to sex, age, component fixation, and year of surgery, with patients with an MoP or CoP bearing. We estimated the cumulative incidence of revision taking death as a competing risk into consideration and performed competing risk regression with revision or death as end points.
RESULTS
There was no difference in the overall risk of revision between the DMC group and the propensity-score-matched MoP/CoP group (adjusted hazard ratio [HR] = 1.18; 95% confidence interval [95% CI] = 0.87 to 1.62). Patients with a DMC bearing had a lower risk of revision due to dislocation (adjusted HR = 0.09; 95% CI = 0.03 to 0.29) but a higher risk of revision caused by infection (adjusted HR = 3.20; 95% CI = 1.49 to 6.85).
CONCLUSIONS
There was no difference in overall risk of revision between the DMC and MoP/CoP groups. The DMCs protected against revision due to dislocation but THAs performed with this bearing were more commonly revised because of infection. There may have been a selection bias toward placing DMC implants in patients with greater frailty as the mortality rates were higher in the DMC group than in the age and sex-matched MoP/CoP group.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
双动髋臼杯（DMC）旨在降低假体的不稳定性，因其在初次和翻修全髋关节置换术（THA）中都有良好的应用而广受欢迎。我们比较了使用 DMC 与使用金属对聚乙烯（MoP）或陶瓷对聚乙烯（CoP）轴承的初次 THA 患者中，因原发性骨关节炎而进行翻修的风险。
方法
对北欧关节置换注册协会（NARA）数据库进行检索，找出 1995 年至 2013 年间使用 DMC 进行的 THA。通过倾向评分匹配，2277 例患者被匹配（1:1），匹配因素包括性别、年龄、组件固定和手术年份，以及使用 MoP 或 CoP 轴承的患者。我们考虑到死亡作为竞争风险，估计了考虑死亡作为竞争风险的翻修累积发生率，并以翻修或死亡为终点进行竞争风险回归。
结果
DMC 组与匹配的 MoP/CoP 组之间，翻修的总体风险无差异（校正后的危险比[HR] = 1.18；95%置信区间[95%CI] = 0.87 至 1.62）。使用 DMC 轴承的患者因脱位而翻修的风险较低（校正 HR = 0.09；95%CI = 0.03 至 0.29），但因感染而翻修的风险较高（校正 HR = 3.20；95%CI = 1.49 至 6.85）。
结论
DMC 与 MoP/CoP 组之间的总体翻修风险无差异。DMC 可预防因脱位而翻修，但因感染而需要翻修的 DMC 髋关节置换术更为常见。由于 DMC 组的死亡率高于年龄和性别匹配的 MoP/CoP 组，因此可能存在将 DMC 植入物放置在更为脆弱的患者中的选择偏倚。
证据等级
治疗性 III 级。请参阅作者说明，以获得完整的证据等级描述。
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