Nessler Joseph M, Malkani Arthur L, Yep Patrick J, Mullen Kyle J, Illgen Richard L
From the University of Wisconsin, Madison, WI, Department of Orthopedics and Rehabilitation (Nessler), University of Louisville, Louisville, KY, Department of Orthopedics Adult Reconstruction Program (Malkani), American Academy of Orthopaedic Surgeons, Chicago, IL (Yep and Mullen), and Department of Orthopedics & Rehabilitation, University of Wisconsin School of Medicine and Public Health, Adult Reconstruction Program, Madison, WI (Illgen).
J Am Acad Orthop Surg. 2023 Mar 1;31(5):e271-e277. doi: 10.5435/JAAOS-D-22-00767. Epub 2022 Dec 29.
Patients undergoing primary total hip arthroplasty (THA) with a previous history of lumbar spine fusion (LSF) are at increased risk of dislocation. The purpose of this study was to compare the 90-day and 1-year dislocation rates of patients with LSF or lumbar degenerative disk disease who underwent primary THA with and without dual mobility (DM) constructs.
An American Joint Replacement Registry data set of patients aged 65 years and older undergoing primary THA with minimum 1-year follow-up with a history of prior LSF or a diagnosis of lumbar degenerative disk disease was created. DM status was identified, and dislocation and all-cause revision at 90 days and 1 year were assessed.
A total of 15,572 patients met study criteria. The overall dislocation rates for the non-DM and DM groups were 1.17% and 0.68%, respectively, at 90 days, and 1.68% and 0.91%, respectively, at 1 year ( P = 0.005). The odds of 90-day (OR = 0.578, [ P = 0.0328]) and 1-year (OR = 0.534, [ P = 0.0044]) dislocation were significantly less with DM constructs, compared with non-DM constructs. No statistically significant difference was observed in revision rates between groups.
This large registry-based study identified a reduced risk of dislocation in patients at risk for spinal stiffness when a DM compared with non-DM construct was used in primary THA at 90-day and 1-year follow-up intervals. Our data support the use of DM constructs in high-risk patients with stiff spines and altered spinopelvic mobility as a promising option to mitigate the risk of postoperative hip instability after primary THA.
Level III. Therapeutic retrospective cohort.
既往有腰椎融合术（LSF）病史的患者在接受初次全髋关节置换术（THA）时脱位风险增加。本研究的目的是比较接受或未接受双动（DM）假体的有LSF病史或腰椎退行性椎间盘疾病的患者在90天和1年时的脱位率。
创建了一个美国关节置换登记数据集，纳入年龄65岁及以上、接受初次THA且至少随访1年、有LSF病史或诊断为腰椎退行性椎间盘疾病的患者。确定DM状态，并评估90天和1年时的脱位及全因翻修情况。
共有15572例患者符合研究标准。非DM组和DM组在90天时的总体脱位率分别为1.17%和0.68%，在1年时分别为1.68%和0.91%（P = 0.005）。与非DM假体相比，使用DM假体时90天（OR = 0.578，[P = 0.0328]）和1年（OR = 0.534，[P = 0.0044]）脱位的几率显著降低。两组之间的翻修率未观察到统计学上的显著差异。
这项基于大型登记处的研究发现，在初次THA术后90天和1年的随访中，与非DM假体相比，使用DM假体时脊柱僵硬风险患者的脱位风险降低。我们的数据支持在脊柱僵硬和脊柱骨盆活动度改变的高危患者中使用DM假体，作为降低初次THA术后髋关节不稳定风险的一种有前景的选择。
III级。治疗性回顾性队列研究。
