Department of Orthopedic Surgery and Trauma, Hospital Galdakao-Usansolo, Bizkaia, Spain; Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao-Usansolo. Osakidetza, Bizkaia, Spain.
Department of Orthopedic Surgery and Trauma, Hospital Galdakao-Usansolo, Bizkaia, Spain; Lower Limb Reconstruction Group. Biocruces Bizkaia Health Research Institute, Hospital Galdakao-Usansolo. Osakidetza, Bizkaia, Spain.
Injury. 2021 Jun;52(6):1467-1472. doi: 10.1016/j.injury.2020.12.032. Epub 2020 Dec 31.
Total hip arthroplasty (THA) after femoral neck fracture (FNF) is associated with an increased risk of dislocation. The goals of our study were (1) to determine dislocation and revision rates when dual-mobility cups (DMCs) are used in these patients, (2) to analyze clinical and radiographic outcomes, survivorship, complications and mortality rate, and (3) to compare results between cemented and cementless cups.
We retrospectively reviewed patients with FNF treated using DMC-THA between 2011 and 2018. A minimum 2-year follow-up was required for clinical and radiographic assessment. The clinical outcome was assessed using the Harris Hip Score (HHS) and Merlé D´Aubigné-Postel score (MDP). Radiolucent lines, osteolysis and cup loosening were analyzed.
We included 105 patients (105 hips) with a mean age of 75.5 years. There were no dislocations. One patient (1.0%) underwent cup revision at 39 months for aseptic cup loosening. The mean HHS and MDP were 80.5 and 14.2 respectively at a mean follow-up of 4.1 years. A higher MDP was found in patients with cementless rather than cemented cups (15.0 vs. 13.1; p = 0.006). Four patients had radiolucent lines > 1 mm, around cemented cups. At 6.8 years, estimated cup survival was 98.2% for revision for aseptic loosening and 97.3% for revision for any reason. The mortality rates were 6.7% at 1 year and 23.8% at last follow-up.
Our findings suggest that using DMC in THA for FNF may prevent dislocation with a low revision rate. Cementless cups had a higher MDP than cemented cups.
股骨颈骨折（FNF）后行全髋关节置换术（THA）与脱位风险增加相关。我们研究的目的是：（1）当使用双动杯（DMC）时，确定这些患者的脱位和翻修率；（2）分析临床和影像学结果、生存率、并发症和死亡率；（3）比较骨水泥型和非骨水泥型杯的结果。
我们回顾性分析了 2011 年至 2018 年间使用 DMC-THA 治疗的 FNF 患者。临床和影像学评估需要至少 2 年的随访。临床结果采用 Harris 髋关节评分（HHS）和 Merle D´Aubigné-Postel 评分（MDP）进行评估。分析了透亮线、骨溶解和杯松动情况。
我们纳入了 105 例（105 髋）患者，平均年龄为 75.5 岁。无脱位发生。1 例（1.0%）患者因无菌性杯松动在 39 个月时行杯翻修。平均随访 4.1 年后，HHS 和 MDP 平均分别为 80.5 和 14.2。非骨水泥型杯的 MDP 高于骨水泥型杯（15.0 比 13.1；p=0.006）。4 例患者有 >1mm 的透亮线，位于骨水泥型杯周围。6.8 年时，因无菌性松动而翻修的估计杯生存率为 98.2%，因任何原因而翻修的估计杯生存率为 97.3%。1 年时的死亡率为 6.7%，最后一次随访时的死亡率为 23.8%。
我们的研究结果表明，在 FNF 患者中使用 DMC 进行 THA 可能会降低脱位风险并降低翻修率。非骨水泥型杯的 MDP 高于骨水泥型杯。
