双动杯在翻修全髋关节置换术中：降低脱位风险的有效策略。
Dual Mobility Cups in Revision Total Hip Arthroplasty: Efficient Strategy to Decrease Dislocation Risk.
机构信息
Orthopaedic Department, Lyon North University Hospital, Lyon, France.
Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia.
出版信息
J Arthroplasty. 2020 Feb;35(2):500-507. doi: 10.1016/j.arth.2019.08.060. Epub 2019 Sep 5.
BACKGROUND
Revision total hip arthroplasty (rTHA) is a challenging surgery with a higher rate of complications than primary arthroplasty, particularly instability and aseptic loosening. The purpose of this study is to compare dual mobility cup (DMC) and standard mobility cup (SMC) in all rTHAs performed at our institution over a decade with a 1 year minimum follow-up.
METHODS
Two hundred ninety-five rTHAs (acetabular only and bipolar revisions) between 2006 and 2016 were retrospectively reviewed. These were divided into those with a DMC (184 revisions) or SMC (111 revisions). Dislocation and complications requiring re-revision were reported.
RESULTS
The rTHA mean age was 69 years ± 13.9 (19-92) and the mean follow-up was 2.3 years. Dislocation risk was statistically lower (P = .01) with a DMC (3.8%; 7/184) than with an SMC (13.5%; 15/111). DMC required re-rTHA in 24/184 (13%) for any reason compared to SMC in 19/111 (17.1%) (P = .34). There was no significant difference in early aseptic loosening (P = .28) between the 2 groups. For young patients (≤55 years), results were similar with a lower dislocation rate in the DMC group (P = .24) and no increased risk of early aseptic loosening (P = .49).
CONCLUSION
This study demonstrates that for all rTHA indications DMC compared to SMC has a significantly decreased risk of postoperative dislocation without risk of early aseptic loosening at medium term follow-up. The use of DMC in rTHA is an important consideration particularly with the predicted increased incidence of both primary and revision THA globally.
背景
翻修全髋关节置换术（rTHA）是一项具有挑战性的手术，其并发症发生率高于初次置换术，尤其是不稳定和无菌性松动。本研究的目的是比较我们机构在过去十年中所有 rTHA 中使用双动杯（DMC）和标准动杯（SMC）的结果，随访时间至少为 1 年。
方法
回顾性分析了 2006 年至 2016 年期间行翻修全髋关节置换术（仅髋臼和双极翻修）的 295 例患者。这些患者分为使用 DMC（184 例）或 SMC（111 例）的患者。报告脱位和需要再次翻修的并发症。
结果
rTHA 的平均年龄为 69 岁±13.9（19-92）岁，平均随访时间为 2.3 年。DMC 的脱位风险明显较低（P=0.01）（3.8%，7/184），而 SMC 的脱位风险较高（13.5%，15/111）。由于任何原因，DMC 组中有 24/184（13%）需要再次翻修 rTHA，而 SMC 组中有 19/111（17.1%）需要再次翻修（P=0.34）。两组早期无菌性松动无显著差异（P=0.28）。对于年轻患者（≤55 岁），DMC 组的脱位率较低（P=0.24），早期无菌性松动的风险无增加（P=0.49），结果相似。
结论
本研究表明，对于所有 rTHA 适应证，与 SMC 相比，DMC 术后脱位风险显著降低，中期随访无早期无菌性松动风险。在全球范围内，预计初次和翻修 THA 的发生率都将增加，因此在 rTHA 中使用 DMC 是一个重要的考虑因素。
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