由于髋部骨折，全髋关节置换术中双动杯降低了返修风险：来自北欧关节置换注册协会（NARA）的 9040 例配对分析。
Reduced Revision Risk for Dual-Mobility Cup in Total Hip Replacement Due to Hip Fracture: A Matched-Pair Analysis of 9,040 Cases from the Nordic Arthroplasty Register Association (NARA).
机构信息
Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden.
The Swedish Hip Arthroplasty Register, Registercentrum VGR, Gothenburg, Sweden.
出版信息
J Bone Joint Surg Am. 2019 Jul 17;101(14):1278-1285. doi: 10.2106/JBJS.18.00614.
BACKGROUND
The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation.
METHODS
Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match 4,520 hip fractures treated with a DMC to 4,520 hip fractures treated with conventional THA (control group). Competing risk regression analyses with revision or death as the end point were used. Revision was defined as a secondary surgical procedure in which any component of the implant was removed or exchanged. In addition, revision of the cup was analyzed.
RESULTS
The DMCs had a lower risk of revision compared with conventional THA, with an adjusted hazard ratio (AHR) of 0.75 (95% confidence interval [CI] = 0.62 to 0.92). This was consistent after adjusting for surgical approach. DMCs had a lower risk of revision due to dislocation (AHR = 0.45 [95% CI = 0.30 to 0.68]) but we found no difference regarding revision for deep infection. Revision of the acetabular component, both in general and due to dislocation, was more frequent with the use of conventional cups. The risk of death was higher in the DMC group (AHR = 1.49 [95% CI = 1.40 to 1.59]).
CONCLUSIONS
The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. The total number of DMCs analyzed (4,520) likely exceeds any cohort of DMC-treated fractures published to date.
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）在假体头和外金属壳之间有一个额外的由可移动聚乙烯组成的轴承。这种设计在翻修全髋关节置换术（THA）和股骨颈骨折的初次治疗中很受欢迎，预计降低了 THA 不稳定的风险。我们的主要目的是基于北欧关节置换登记协会（NARA）数据库的数据评估这些髋臼杯的总体翻修风险，我们的次要目的是研究包括脱位在内的具体翻修原因。
方法
采用年龄、性别、髋臼杯和柄的固定以及手术年份（2001 年至 2014 年）的倾向评分匹配，将 4520 例股骨颈骨折患者（DMC 治疗组）与 4520 例股骨颈骨折患者（传统 THA 对照组）进行匹配。使用以翻修或死亡为终点的竞争风险回归分析。翻修定义为任何植入物的组件被移除或更换的二次手术。此外，还分析了髋臼杯的翻修。
结果
与传统 THA 相比，DMC 的翻修风险较低，调整后的危险比（AHR）为 0.75（95%置信区间[CI]为 0.62 至 0.92）。调整手术入路后结果仍然一致。DMC 因脱位而翻修的风险较低（AHR = 0.45[95%CI = 0.30 至 0.68]），但我们发现深感染方面没有差异。常规杯使用髋臼杯组件翻修的发生率更高，无论是一般翻修还是因脱位导致的翻修。DMC 组的死亡率较高（AHR = 1.49[95%CI = 1.40 至 1.59]）。
结论
将 DMC 作为股骨颈骨折的初次治疗方法，总体上和特别是因脱位导致的翻修风险较低。分析的 DMC 总数（4520 个）可能超过迄今为止发表的任何一组 DMC 治疗骨折的数量。
证据水平
治疗 III 级。请参阅作者说明以获取完整的证据水平描述。
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