Department of Orthopaedics. A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.
Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.
J Biol Regul Homeost Agents. 2019 Mar-Apr;33(2 Suppl. 1):63-67. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata.
Dislocation after hip revision is a frequent complication; amongst the strategies to prevent dislocation dual mobility (DM) implants are gaining popularity. We want to evaluate the reliability of non cemented DM cups with multihole metal back and chrome-cobalt liner called Modular Dual Mobility (MDM). We performed a systematic review and selected 5 studies with a total of 285 hips who underwent revision surgery with MDM implants. The mean survivorship rate of the 5 studies was 92.46% (range 90-96%). 267 prosthesis (93.6%) were still implanted at the last follow-up; the mean weighted follow up was 38.7% (range 24-48). We found 13 mechanical complications in 285 hips (4.5%). Five of them were treated conservatively; the other 8 were treated with re-revision. Nine of these complications were dislocation and recurrent instability; 2 of them were associated to metallosis and adverse local tissue reaction. There was 1 patient that had episodes of subluxation; 2 cases of impingement and 1 case of metallosis. Zero intraprosthetic dislocations (IPD) occurred in 285 hips. A 93.6% survivorship is a good result for MDM implants, considering that most of patients had important bone loss and went through multiple revisions. The rate of dislocation is very low compared to the mean rate of dislocation in revision hip surgery. In our review, fretting is a rare complication but it can lead to ALTR and metallosis. For this reason, MDM implants have to be used in selected cases at high risk of dislocation. In conclusion MDM is a great option for decreasing dislocation rate in hip revision, but a longer follow-up and a greater number of cases is needed to assess its reliability.
髋关节翻修后脱位是一种常见的并发症；为了预防脱位，双动（DM）植入物越来越受欢迎。我们想评估具有多孔金属背衬和铬钴衬里的非骨水泥 DM 杯（称为模块化双动（MDM））的可靠性。我们进行了系统评价，选择了 5 项共 285 例髋关节接受 MDM 植入物翻修手术的研究。5 项研究的平均生存率为 92.46%（范围为 90-96%）。267 个假体（93.6%）在最后一次随访时仍植入；平均加权随访时间为 38.7%（范围为 24-48）。我们在 285 例髋关节中发现了 13 例机械并发症（4.5%）。其中 5 例保守治疗；其余 8 例接受再次翻修。这些并发症中有 9 例是脱位和复发性不稳定；其中 2 例与金属沉着症和不良局部组织反应有关。有 1 例患者出现半脱位；2 例撞击，1 例金属沉着症。285 例髋关节中无 1 例假体内脱位（IPD）。考虑到大多数患者存在严重的骨质流失并经历了多次翻修，MDM 植入物的 93.6%生存率是一个很好的结果。与髋关节翻修手术的平均脱位率相比，脱位率非常低。在我们的综述中，磨损是一种罕见的并发症，但它会导致 ALTR 和金属沉着症。因此，MDM 植入物必须在高脱位风险的情况下选择性使用。总之，MDM 是降低髋关节翻修后脱位率的一个很好的选择，但需要更长的随访时间和更多的病例来评估其可靠性。
