Service de chirurgie orthopédique et traumatologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite cedex, France.
Service de chirurgie orthopédique et traumatologique, Hospices Civils de Lyon, Hôpital Lyon Sud, Service de Chirurgie Orthopédique et Traumatologique, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite cedex, France; LBMC UMRT_9406, université de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMRT_9406, Lyon, France.
Orthop Traumatol Surg Res. 2022 Feb;108(1):103164. doi: 10.1016/j.otsr.2021.103164. Epub 2021 Dec 1.
The choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants.
Our hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses.
A retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60-104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk.
The mean follow-up was 6 years±0.5 (5-7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9-5.4) and 3% (95% CI: 1.2-6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8-7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5-11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2-6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7-14.8). The mean HOOS JR score was 79±5 (52-92).
The cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures.
IV; retrospective study without control group.
在股骨颈骨折的全髋关节置换治疗中，植入物类型的选择仍存在争议。一些作者主张系统使用骨水泥型假体，而另一些作者则不首先使用双动假体。因此，我们进行了一项回顾性研究，使用双动杯（DMC）和非骨水泥领型假体（UCS），以：（1）证实该适应证下脱位率低，（2）评估其他手术并发症，特别是假体周围骨折，（3）确保这些益处随时间保持，随访时间至少为 5 年，（4）评估假体的翻修率。
我们的假设是，双动假体治疗股骨颈骨折的脱位率低于双极半髋关节置换术或单动髋关节假体。
回顾性分析了 2013 年至 2014 年期间采用 DMC 和 UCS 治疗的 244 例股骨颈骨折（242 例患者）。平均年龄 83±10 岁（60-104 岁）。记录脱位、假体周围骨折、手术部位感染、松动、再次手术和翻修的发生情况。收集 HOOS 关节置换（JR）评分。累积死亡率作为竞争风险。
平均随访时间为 6 年±0.5（5-7 年）。最后一次随访时，108 例患者（50%）死亡。23 例（9.5%）失访。观察到 1 例 DMC 无症状性无菌性松动。5 年时脱位和假体周围骨折的累积发生率分别为 2%（95%CI：0.9-5.4）和 3%（95%CI：1.2-6）。5 年时手术部位感染的累积发生率为 3.5%（95%CI：1.8-7）。5 年时再次手术的累积发生率为 7%（95%CI：4.5-11）。再次手术的原因包括假体周围骨折（n=6）、感染（n=8）、术后血肿（n=2）和杯位置不当（n=2）。5 年时翻修的累积发生率为 2.7%（95%CI：1.2-6）。5 年时任何原因导致的手术并发症的累积发生率为 9%（95%CI：6.7-14.8）。HOOS JR 平均评分为 79±5（52-92）。
在股骨颈骨折中，DMC 联合 UCS 5 年的脱位累积发生率较低，在此期间其他手术并发症（包括假体周围骨折）不会增加。在股骨颈骨折的治疗中，使用这种类型的植入物是可靠的。
IV；无对照组的回顾性研究。
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