双动型与固定承重型全髋关节置换术早期脱位情况对比：对可比队列的多中心分析
Lack of early dislocation for dual mobility vs. fixed bearing total hip arthroplasty: A multi-center analysis of comparable cohorts.
作者信息
Dubin J A, Westrich G H
机构信息
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th, Street, NY, NY, 10021, USA.
出版信息
J Orthop. 2020 Feb 4;21:1-5. doi: 10.1016/j.jor.2020.02.006. eCollection 2020 Sep-Oct.
BACKGROUND
Dislocation is a major cause of morbidity and revision surgery following total hip arthroplasty (THA). To address such issues, dual mobility (DM) bearings were introduced as a more stable alternative to fixed-bearing (FB) prostheses. As such, we compared DM and FB systems in a cohort study in terms of dislocations, readmissions, and revisions.
METHODS
A 27 multi-center retrospective review was performed of 664 DM and 218 FB cases from the same manufacturer with mean follow-up of 2.09 years and 1.83 years, respectively. Patient reported outcome measures (PROMs) including Harris Hip Score (HHS), SF12, EQ5D, and Lower Extremity Activity Score (LEAS) were evaluated as well as dislocation rates, readmissions, and revisions rates. We also performed a survivorship analysis through Kaplan-Meier estimator. Students -test was used for normally distributed continuous data and Fisher exact test (P < 0.05) was used for discrete data.
RESULTS
There were 0 dislocations in the DM (0%) group and 2 dislocations in the FB (0.92%) group (p = 0.06). Latest follow up HHS revealed a significant difference between groups (91.44 DM and 87.81 FB; p = 0.006). In addition, there was significant difference between DM and FB on SF12 Physical Component Score (PCS) (46.83 and 44.55, respectively, p = 0.015). Also, readmission rates at 30, 60 and 90 days remained lower for DM than for FB at each time point (1.05% vs. 2.75%, 1.81% vs. 2.75%, and 1.81% vs. 2.75, respectively). Overall, DM had a lower revision rate at 1.51% compared to 2.29% for FB (p = 0.24). The revision breakdown for DM revealed 0 (0%) for both Anatomic Dual Mobility (ADM) and Modular Dual Mobility (MDM) due to the acetabular component.) There was a difference, 14 (87.5%) for ADM and 2 (12.5%) due to the femoral component. The survivorship analysis revealed no significance difference between DM and FB at 4 years (97.90% and 97.26%, respectively).
CONCLUSION
In comparison to patients who undergo FB THA, DM bearings have improved PROMs and a lower rate of dislocation, readmission, and revision.
背景
脱位是全髋关节置换术（THA）后发病和翻修手术的主要原因。为解决此类问题，双动（DM）轴承作为一种比固定轴承（FB）假体更稳定的替代品被引入。因此，我们在一项队列研究中比较了DM和FB系统在脱位、再入院和翻修方面的情况。
方法
对来自同一制造商的664例DM病例和218例FB病例进行了一项27中心的回顾性研究，平均随访时间分别为2.09年和1.83年。评估了患者报告的结局指标（PROMs），包括Harris髋关节评分（HHS）、SF12、EQ5D和下肢活动评分（LEAS），以及脱位率、再入院率和翻修率。我们还通过Kaplan-Meier估计器进行了生存分析。对于正态分布的连续数据使用学生t检验，对于离散数据使用Fisher精确检验（P < 0.05）。
结果
DM组（0%）无脱位，FB组有2例脱位（0.92%）（p = 0.06）。最新随访时的HHS显示两组之间存在显著差异（DM为91.44，FB为87.81；p = 0.006）。此外，DM和FB在SF12身体成分评分（PCS）上存在显著差异（分别为46.83和44.55，p = 0.015）。而且，DM在30天、60天和90天的再入院率在每个时间点都低于FB（分别为1.05%对2.75%、1.81%对2.75%、1.81%对2.75%）。总体而言，DM的翻修率为1.51%，低于FB的2.29%（p = 0.24）。DM的翻修分类显示，由于髋臼组件，解剖型双动（ADM）和模块化双动（MDM）均为0例（0%）。存在差异的是，ADM因股骨组件有14例（87.5%），FB有2例（12.5%）。生存分析显示，4年时DM和FB之间无显著差异（分别为97.90%和97.26%）。
结论
与接受FB THA的患者相比，DM轴承改善了PROMs，且脱位、再入院和翻修率更低。
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