Iorio Raffaele, Iannotti Ferdinando, Mazza Daniele, Speranza Attilio, Massafra Carlo, Guzzini Matteo, D'Arrigo Carmelo, Ferretti Andrea
Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy.
SICOT J. 2019;5:38. doi: 10.1051/sicotj/2019035. Epub 2019 Nov 1.
Treatment of patients with dementia and hip fracture is challenging. Total hip arthroplasty (THA) with dual mobility cup (DMC) has been designed to reduce the rate of dislocation by increasing the stability of the implant. This study aimed to compare the dislocation rates of DMC THA with hemiarthroplasty (HA) in elderly patients with displaced femoral neck fracture (FNF) and a diagnosis of dementia.
All patients with a displaced FNF and dementia diagnosis were prospectively randomized to hemiarthroplasty or THA with DMC treatment during a 2-year period. Finally, the outcomes of 30 patients in the HA group were compared with those of 30 patients in the DMC THA group. Dislocation rate at a minimum follow-up of 1 year was evaluated as the primary outcome. Reoperation rate, time to surgery, surgical time, length of hospital stay, and 30-day and 1-year mortality were also evaluated.
There was a significant difference regarding rates of dislocation in favor of THA with DMC and with regard to length of surgery (p = 0.04) in favor of bipolar HA. Dislocation occurred in five patients (16.6%) treated with bipolar HA and no one (0%) in patients treated with THA with DMC (p = 0.019). There was no difference with regard to the 30-day mortality, 1-year mortality, reoperations, and length of hospital stay between the two groups of patients.
THA with DMC seems to be a safe and reliable choice to reduce the rate of dislocation at 1 year in patients with dementia and FNF without a higher risk of mortality.
治疗患有痴呆症和髋部骨折的患者具有挑战性。双动髋臼杯（DMC）全髋关节置换术（THA）旨在通过增加植入物的稳定性来降低脱位率。本研究旨在比较DMC THA与半髋关节置换术（HA）在患有股骨颈骨折（FNF）移位且诊断为痴呆症的老年患者中的脱位率。
在2年期间，所有患有FNF移位且诊断为痴呆症的患者被前瞻性随机分配接受半髋关节置换术或DMC治疗的THA。最后，将HA组的30例患者的结果与DMC THA组的30例患者的结果进行比较。将至少随访1年时的脱位率评估为主要结果。还评估了再次手术率、手术时间、手术时长、住院时间以及30天和1年死亡率。
在脱位率方面，DMC THA组更具优势，在手术时长方面，双极HA组更具优势（p = 0.04）。双极HA治疗的5例患者（16.6%）发生了脱位，而DMC THA治疗的患者中无人脱位（0%）（p = 0.019）。两组患者在30天死亡率、1年死亡率、再次手术和住院时间方面没有差异。
对于患有痴呆症和FNF的患者，DMC THA似乎是一种安全可靠的选择，可降低1年时的脱位率，且不会增加更高的死亡风险。
