Royal Cornwall Hospital, Treliske, Truro, TR1 3LJ.
Exeter University Medical School, Stocker Rd, Exeter EX4 4PY.
Injury. 2021 Oct;52(10):3017-3021. doi: 10.1016/j.injury.2021.01.027. Epub 2021 Jan 21.
Hip fracture is a common and serious injury in the elderly. Hip arthroplasty is the most frequently performed procedure for patients with an intracapsular hip fracture. The majority of national guidelines recommend total hip arthroplasty (THA) for more active patients. Literature indicates significant stability advantages for dual mobility (DM) acetabular components in non-emergent scenarios. Evidence supporting the use of DM in hip fracture patients is limited.
We set out to ascertain if DM implants offer stability and/or functional advantages over standard THA in patients with hip fracture.
We utilised our local National Hip Fracture Database to identify all patients undergoing either a standard or DM THA for hip fracture (n=477) We matched cohorts based on age, AMTS, mobility status pre-operatively, gender, ASA and source of admission. Our primary outcome of interest was functional status using the oxford hip score (OHS). Secondary outcome measures included dislocation, fracture and deep infection requiring further surgery.
62 patient pairs were available for this study. Mean OHS for DM THA was 41.5 and for standard THA this was 42.7 (p=0.58). There were 4 dislocations in the standard THA group and 0 with DM THA. No difference was seen with infection or peri-prosthetic fracture.
This study demonstrates functional equivalence between DM and standard THA. In addition it shows a trend towards less dislocation with DM THA. Cost savings from less instability may outweigh initial prosthesis costs. This study suggests a suitably powered RCT using instability as the primary outcome measure is indicated.
髋部骨折是老年人中常见且严重的损伤。髋关节置换术是治疗囊内髋部骨折患者最常进行的手术。大多数国家指南建议对更活跃的患者进行全髋关节置换术（THA）。文献表明，在非紧急情况下，双动（DM）髋臼组件具有显著的稳定性优势。支持在髋部骨折患者中使用 DM 的证据有限。
我们旨在确定在髋部骨折患者中，DM 植入物是否在稳定性和/或功能方面优于标准 THA。
我们利用当地的国家髋部骨折数据库，确定所有接受标准或 DM THA 治疗髋部骨折的患者（n=477）。我们根据年龄、AMTS、术前活动能力、性别、ASA 和入院来源对队列进行匹配。我们感兴趣的主要结果是使用牛津髋关节评分（OHS）评估的功能状态。次要结果指标包括脱位、骨折和需要进一步手术的深部感染。
本研究有 62 对患者可供研究。DM THA 的平均 OHS 为 41.5，标准 THA 为 42.7（p=0.58）。标准 THA 组有 4 例脱位，DM THA 组无脱位。感染或假体周围骨折无差异。
本研究表明 DM 和标准 THA 之间具有功能等效性。此外，DM THA 脱位的趋势较小。减少不稳定性带来的成本节约可能超过初始假体成本。这项研究表明，需要进行一项具有足够效力的 RCT，以不稳定性作为主要结局指标。
