Agarwala Sanjay, Katariya Ameya, Vijayvargiya Mayank, Shetty Vivek, Swami Pravin Manohar
Chief of Surgery and Director Professional Services, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India.
Resident doctor, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India.
SICOT J. 2021;7:42. doi: 10.1051/sicotj/2021041. Epub 2021 Aug 17.
Total Hip Replacement (THR) in displaced Fracture Neck of Femur (FNOF) is associated with higher dislocation rates. Conventional THR with a large femoral head and anterior approach has reduced the instability, but it remains higher than THR done for other aetiology. Recent studies have shown reduced dislocation rates with dual mobility THR (DMTHR) for FNOF; however, there is a lack of comparative research to show its superiority over conventional THR. Further, its role in the Asian subcontinent, where the patient requires sitting cross-legged or squatting, has not been studied.
A prospective cohort study of 103 elderly patients with displaced FNOF with a minimum follow-up of 1-year. Fifty-two patients were operated on with DMTHR and fifty-one patients with conventional THR. Both the groups were matched in terms of demographic data, surgical approach, and postoperative protocol. Radiological and functional outcomes in terms of Harris Hip Score (HHS), Range of motion, Patient Reported Outcome Measures (PROM), and Dislocation rate were compared between the two groups.
Mean HHS of the DMTHR group was 76.37 at three months and 87.02 at the end of the 1-year postoperatively, which was significantly better than the conventional THR group 65.65 at three months and 72.96 at 1-year. The range of motion was significantly better in the DMTHR group than the conventional THR group. There was no significant difference in radiological outcomes and postoperative dislocation rate between the two groups.
Dual mobility implants give better results than conventional implants for primary THA in elderly patients of displaced FNOF regarding better function and greater range of motion.
股骨颈移位骨折（FNOF）行全髋关节置换术（THR）时脱位率较高。采用大股骨头和前路入路的传统THR已降低了不稳定性，但仍高于因其他病因行THR的情况。最近的研究表明，FNOF采用双动全髋关节置换术（DMTHR）可降低脱位率；然而，缺乏比较研究来证明其优于传统THR。此外，在亚洲次大陆，患者有盘腿坐或蹲的需求，DMTHR在这方面的作用尚未得到研究。
对103例股骨颈移位骨折的老年患者进行前瞻性队列研究，随访至少1年。52例患者接受DMTHR手术，51例患者接受传统THR手术。两组在人口统计学数据、手术入路和术后方案方面进行匹配。比较两组在Harris髋关节评分（HHS）、活动范围、患者报告结局指标（PROM）和脱位率方面的放射学和功能结局。
DMTHR组术后3个月的平均HHS为76.37，术后1年结束时为87.02，明显优于传统THR组，后者术后3个月为65.65，1年时为72.96。DMTHR组的活动范围明显优于传统THR组。两组在放射学结局和术后脱位率方面无显著差异。
对于老年股骨颈移位骨折患者的初次全髋关节置换术，双动植入物在功能和活动范围方面比传统植入物效果更好。
