Wakeling Christopher P, Sandiford Nemandra A, Ghani Rafia, Bridle Simon J, Mitchell Philip A, Hutt Jonathan Rb
St. Richard's Hospital, Western Sussex Hospitals NHS Foundation Trust, Chichester, UK.
St. George's Hospital NHS Foundation Trust, London, UK.
Hip Int. 2022 Jul;32(4):460-465. doi: 10.1177/1120700021999795. Epub 2021 Mar 18.
Revision total hip arthroplasty (rTHA) is associated with an increased dislocation risk. Dual-mobility (DM) bearings have been used to address this issue. Such constructs offer increased range of motion and enhanced stability whilst avoiding some issues associated with fully-constrained devices. DM bearings have been used in our unit since 2013.
All rTHA cases since 2013 were reviewed using the following criteria: (1) use of a DM bearing; (2) extensive soft tissue or bone loss resulting from ARMD, infection or multiple revisions, or requiring custom or megaprosthetic reconstruction; (3) minimum 2-month follow-up.
52 cases were identified with a median of 2 previous operations (range 1-6) and mean follow-up of 14 (2-41) months. The Novae-Stick component was used in 50 cases, the Avantage in 2 and the Trident MDM in 1 case. 19 required acetabular reconstruction using trabecular metal and four required custom acetabular components. 19 required femoral reconstruction with a proximal or total femoral replacement.Postoperatively, 8 patients (15.4%) sustained a dislocation at a mean of 1.6 (range 1-3) months. 3 (5.8%) requiring re-revision. 1 required excision arthroplasty and 2 a constrained liner, 1 of which went on to have further instability. There were no intraprosthetic dislocations.
Dual-mobility components are a viable option in the complex rTHA setting. Early dislocations can occur but the rate of instability is acceptable in this high-risk group.
全髋关节翻修术（rTHA）与脱位风险增加相关。双动（DM）轴承已被用于解决这一问题。此类结构提供了更大的活动范围和更高的稳定性，同时避免了一些与全约束装置相关的问题。自2013年以来，DM轴承已在我们科室使用。
对2013年以来的所有rTHA病例进行如下标准的回顾：（1）使用DM轴承；（2）因髋臼发育不良、感染或多次翻修导致广泛的软组织或骨质丢失，或需要定制或使用大型假体进行重建；（3）至少随访2个月。
共确定52例患者，之前手术的中位数为2次（范围1 - 6次），平均随访14个月（2 - 41个月）。50例使用了Novae-Stick组件；2例使用了Avantage组件；1例使用了Trident MDM组件。19例需要使用小梁金属进行髋臼重建，4例需要定制髋臼组件。19例需要进行股骨近端或全股骨置换的股骨重建。术后，8例患者（15.4%）发生脱位，平均时间为1.6个月（范围1 - 3个月）。3例（5.8%）需要再次翻修。1例需要行关节切除成形术，2例需要使用限制性衬垫，其中1例随后出现进一步不稳定。未发生假体内部脱位。
在复杂的rTHA情况下，双动组件是一种可行的选择。早期脱位可能发生，但在这个高风险组中，不稳定率是可以接受的。
