Department of Traumatology and Orthopaedic Surgery, Río Hortega University Hospital, 47012 Valladolid, Spain.
Department of Traumatology and Orthopaedic Surgery, Infanta Sofía University Hospital, 28703 Madrid, Spain.
Medicina (Kaunas). 2022 Apr 9;58(4):528. doi: 10.3390/medicina58040528.
Total hip arthroplasty (THA) is considered the most successful surgical procedure in orthopedics. However, dislocation remains the main indication for surgical revision. New designs of dual mobility cups (DMC) have lowered the classical complications and have extended the indications of DMC in elective surgeries. Our aim is to assess the trend of DMC indications in THA as well as the incidence of their dislocation. We retrospectively reviewed all patients undergoing THA with DMC during the years 2015 and 2021. The original indication for DMC included patients sustaining neck of femur fractures (NOF#) and associated risk factors for dislocations. Five years later, DMC was considered our standard of care in total hip arthroplasty. The approach (anterolateral or posterolateral) was chosen by the surgeon according to his/her preferences, as was the implant. Data collected included patients' demographics, diagnosis, admission time, surgical approach, cup models, and inclination and complications. Patients sustaining a hip dislocation were prospectively reviewed and assessed for treatment received, new dislocations, and need for surgical revision. Two groups were created for the analysis according to the presence or absence of dislocation during follow-up. In the analysis, 531 arthroplasties were included (mean age 72.2 years) with a mean follow-up of 2.86 years. The trend of indications for DMC increased from 16% of THA in 2015 to 78% of THA in 2021. We found a total of 8 dislocations (1.5%), none of them associated with elective surgery. Closed reduction was unsatisfactory in four cases (50%). There was one case of intraprosthetic dislocation. Dislocations were associated to smaller heads (22 mm) (1.5% vs. 25%, = 0.008) and cups (51.2 mm vs. 48.7 mm, = 0.038) and posterior approach (62.5% vs. 37.5%, = 0.011). Dual mobility cups are a great option to reduce the risk of dislocation after a THA both in the neck of femur fractures and elective cases. The use of an anterolateral approach in THA after a neck or femur fracture might considerably decrease the risk of dislocation.
全髋关节置换术 (THA) 被认为是骨科领域最成功的手术之一。然而，脱位仍然是手术翻修的主要指征。双动杯 (DMC) 的新设计降低了经典并发症，并扩大了 DMC 在择期手术中的适应证。我们的目的是评估 DMC 在 THA 中的适应证趋势以及其脱位的发生率。
我们回顾性分析了 2015 年至 2021 年间所有接受 DMC 行 THA 的患者。DMC 的原始适应证包括股骨颈骨折（NOF#）患者和脱位相关的危险因素。五年后，DMC 被认为是我们全髋关节置换术的标准治疗方法。手术入路（前外侧或后外侧）由外科医生根据自己的偏好选择，植入物也是如此。收集的数据包括患者的人口统计学资料、诊断、入院时间、手术入路、杯模型以及倾斜度和并发症。发生髋关节脱位的患者前瞻性接受评估，评估治疗方法、新脱位和是否需要手术翻修。根据随访期间是否存在脱位，将患者分为两组进行分析。
在分析中，纳入了 531 例关节置换术（平均年龄 72.2 岁），平均随访 2.86 年。DMC 的适应证趋势从 2015 年的 THA 占 16%增加到 2021 年的 THA 占 78%。我们共发现 8 例脱位（1.5%），均与择期手术无关。4 例（50%）闭合复位不满意。有 1 例假体脱位。脱位与较小的股骨头（22mm）（1.5%比 25%，=0.008）和杯（51.2mm 比 48.7mm，=0.038）以及后入路（62.5%比 37.5%，=0.011）有关。
双动杯是降低 THA 后股骨颈骨折和择期病例脱位风险的绝佳选择。股骨颈或股骨骨折后行 THA 采用前外侧入路可能会大大降低脱位的风险。
