AutoRSA Research Group, Orthopeadic Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark.
Biomechanics and Imaging Group, Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5957-5965. doi: 10.1007/s00402-023-04774-5. Epub 2023 Feb 21.
Dual mobility implants have been successful in reducing postoperative hip dislocation but mid-term results of cup migration and polyethylene wear are missing in the literature. Therefore, we measured migration and wear at 5-year follow-up using radiostereometric analysis (RSA).
A cohort of 44 patients (mean age 73, 36 female) with heterogeneous indications for hip arthroplasty but all with a high risk of hip dislocation received total hip replacement (THA) with The Anatomic Dual Mobility X3 monoblock acetabular construct and a highly crosslinked polyethylene liner. RSA images and Oxford Hip Scores were obtained perioperatively and 1, 2, and 5 years postoperatively. Cup migration and polyethylene wear were calculated using RSA.
Mean 2-year proximal cup translation was 0.26 mm (95% CI 0.17; 0.36). Proximal cup translation was stable from 1- to 5-year follow-up. Mean 2-year cup inclination (z-rotation) was 0.23° (95% CI - 0.22; 0.68) and was greater in patients with osteoporosis compared to patients without osteoporosis (p = 0.04). Using 1-year follow-up as baseline, the 3D polyethylene wear rate was 0.07 mm/year (0.05; 0.10). Oxford hip scores improved 19 (95% CI 14; 24) points from mean 21 (range 4; 39) at baseline, to 40 (9; 48) 2 years postoperatively. There were no progressive radiolucent lines > 1 mm. There was 1 revision for offset correction.
Anatomic Dual Mobility monoblock cups were well-fixed, the polyethylene wear rate was low, and the clinical outcomes were good until 5-year follow-up suggesting good implant survival in patients of different age groups and with heterogeneous indications for THA.
双动式假体在降低术后髋关节脱位方面取得了成功,但文献中缺乏中期随访时髋臼杯迁移和聚乙烯磨损的结果。因此,我们使用放射学体层摄影测量分析(RSA)测量了 5 年随访时的迁移和磨损情况。
一组 44 例(平均年龄 73 岁,36 例女性)患者,髋关节置换术的适应证不同,但均有髋关节脱位的高风险,接受了全髋关节置换术(THA),使用解剖型双动式 X3 整体式髋臼假体和高交联聚乙烯衬垫。在术前、术后 1、2 和 5 年时获得 RSA 图像和牛津髋关节评分。使用 RSA 计算髋臼杯的迁移和聚乙烯磨损。
平均 2 年时近端髋臼杯的平移为 0.26mm(95%CI 0.17;0.36)。1 至 5 年随访时近端髋臼杯的位置稳定。平均 2 年时髋臼杯的倾斜(Z 轴旋转)为 0.23°(95%CI -0.22;0.68),骨质疏松患者的倾斜角度大于非骨质疏松患者(p=0.04)。以 1 年随访为基线,3D 聚乙烯磨损率为 0.07mm/年(0.05;0.10)。牛津髋关节评分从基线时的平均 21 分(范围 4 至 39)提高了 19 分(95%CI 14 至 24),至术后 2 年时的 40 分(9 至 48)。没有进展性大于 1mm 的透亮线。有 1 例因偏移矫正而进行了翻修。
解剖型双动式整体式髋臼杯固定良好,聚乙烯磨损率低,临床结果良好,至 5 年随访时仍保持良好,提示不同年龄组和髋关节置换术适应证不同的患者有较好的假体存活率。