Dubin J A, Westrich G H
Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2019 Dec 6;5(4):509-514. doi: 10.1016/j.artd.2019.09.006. eCollection 2019 Dec.
Dual mobility (DM) has been used in primary total hip arthroplasty recently for their low dislocation rates, low revision rates, and improved patient functional outcomes. We compared 2 DM systems, anatomic dual mobility (ADM; Stryker, Mahwah, NJ) and modular dual mobility (MDM; Stryker, Mahwah, NJ), to determine differences in dislocation rates, revision rates, and patient outcome scores.
The study was a single-center matched retrospective review of prospectively collected data of patients who underwent primary total hip arthroplasty surgery with an ADM or MDM system by a single surgeon from 2012 to 2017. Demographics, operative details, postoperative patient-reported outcomes, and clinical outcomes were recorded. A Kaplan-Meier survivorship curve to compare survival time between groups was collected as well.
Five hundred seventy-four patients were included in the study with 287 patients matched in each group with mean 2.86 years of follow-up. The dislocation rate in each cohort was 0%, the acetabular-specific revision rate was 0%, and in each cohort, overall revision rate in each cohort was 1.7%. In general, patient-reported outcomes were similar for each group (Harris Hip Score Pain ( = .919), Harris Hip Score Function ( = .736), Western Ontario and McMaster Universities Osteoarthritis Index ( = .139), Pain Visual Analog Scale ( = .146), Veterans RAND 12-Item Health Survey ( = .99), University of California, Los Angeles ( = .417), and Harris Hip Score Total ( = .136). There was a slight clinically insignificant increase in hip flexion between the cohorts favoring the ADM group (98.6 ± 9.8 vs 94.0 ± 9.7, < .001).
Both DM systems had similar patient-reported outcomes that were quite favorable. At 2.86 years of follow-up, neither the ADM nor MDM systems demonstrated dislocation, and both had low acetabular-specific and overall revision rates in this matched cohort study.
双动(DM)髋关节假体最近已应用于初次全髋关节置换术,因其脱位率低、翻修率低且患者功能预后得到改善。我们比较了两种双动系统,解剖型双动(ADM;史赛克公司,新泽西州马霍瓦)和模块化双动(MDM;史赛克公司,新泽西州马霍瓦),以确定脱位率、翻修率和患者预后评分的差异。
本研究是一项单中心匹配回顾性研究,回顾了2012年至2017年由一名外科医生使用ADM或MDM系统进行初次全髋关节置换手术患者的前瞻性收集数据。记录人口统计学、手术细节、术后患者报告的预后和临床结果。还收集了Kaplan-Meier生存曲线以比较组间生存时间。
574例患者纳入研究,每组287例匹配患者,平均随访2.86年。每个队列的脱位率为0%,髋臼特异性翻修率为0%,每个队列的总体翻修率为1.7%。总体而言,每组患者报告的预后相似(Harris髋关节评分疼痛(P = 0.919),Harris髋关节评分功能(P = 0.736),西安大略和麦克马斯特大学骨关节炎指数(P = 0.139),疼痛视觉模拟量表(P = 0.146),退伍军人兰德12项健康调查(P = 0.99),加利福尼亚大学洛杉矶分校(P = 0.417),以及Harris髋关节评分总分(P = 0.136)。队列间髋关节屈曲有轻微的、临床上无显著意义的增加,有利于ADM组(98.6±9.8对94.0±9.7,P < 0.001)。
两种双动系统患者报告的预后相似且都相当良好。在2.86年的随访中,ADM和MDM系统均未出现脱位,在这项匹配队列研究中,两者的髋臼特异性和总体翻修率均较低。