Department of Orthopaedics, University Medical Centre, 2000 Maribor, Slovenia.
Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia.
Medicina (Kaunas). 2023 Feb 2;59(2):290. doi: 10.3390/medicina59020290.
: Increased revision rate of dual-modular (DM) femoral stems in primary total hip arthroplasty (THA) because of modular-neck breakage and adverse local tissue reactions (ALTRs) to additional junction damage products is well established and some designs have been recalled from the market. However, some long-term studies of specific DM stems did not confirm the inferiority of these stems compared to standard single-modular (SM) stems, and a head-to-head comparison THA is missing. The objectives of this multicentre study were to determine the survivorship and complication rates of a common DM stem design compared to a similar SM stem. : In a time frame from January 2012 to November 2015, a cohort of 807 patients (882 hips) consecutively underwent primary cementless THAs at two orthopaedic centres. 377 hips were treated with a Zweimüller-type DM stem THA system and 505 hips with a similar SM stem THA system, both including a modern press-fit acetabulum. Kaplan-Meier survivorship and complication rates were compared between both groups in a median follow-up of 9.0 years (maximum, 9.9 years). : The 9-year survivorship of the DM stem THA system (92.6%, 95% CI 89.9-95.3) was significantly lower than that of the SM stem THA system (97.0%, 95% CI 95.2-98.8). There were no differences in revision rates for septic loosening, dislocation, and periprosthetic fractures between the two groups. One ceramic inlay and one Ti-alloy modular neck breakage occurred in the DM stem THA system group, but the main reason for revision in this group was aseptic loosening of components. : The survivorship of the DM stem THA system was lower than the similar SM stem THA system in a comparable clinical environment with long-term follow-up. Our results confirmed that no rationale for stem modularity exists in primary THAs.
: 双模块（DM）股骨柄在初次全髋关节置换术（THA）中因柄颈断裂和对附加连接损伤产物的不良局部组织反应（ALTRs）而需要频繁翻修已得到充分证实，一些设计已从市场召回。然而，一些针对特定 DM 柄的长期研究并未证实这些柄与标准单模块（SM）柄相比存在劣势，并且缺少头对头比较的 THA 研究。本多中心研究的目的是确定一种常见 DM 柄设计与类似 SM 柄相比的生存率和并发症发生率。 : 在 2012 年 1 月至 2015 年 11 月期间，两个骨科中心连续对 807 例患者（882 髋）进行初次非骨水泥 THA。377 髋采用 Zweimüller 型 DM 柄 THA 系统治疗，505 髋采用类似的 SM 柄 THA 系统治疗，两者均包括现代压配髋臼杯。在中位随访 9.0 年（最长 9.9 年）时，比较两组之间的 Kaplan-Meier 生存率和并发症发生率。 : DM 柄 THA 系统 9 年的生存率（92.6%，95%CI 89.9-95.3）明显低于 SM 柄 THA 系统（97.0%，95%CI 95.2-98.8）。两组之间在感染性松动、脱位和假体周围骨折的翻修率方面无差异。DM 柄 THA 系统组发生 1 例陶瓷嵌块和 1 例钛合金模块颈断裂，但该组翻修的主要原因是部件无菌性松动。 : 在具有长期随访的可比临床环境中，DM 柄 THA 系统的生存率低于类似的 SM 柄 THA 系统。我们的结果证实，在初次 THA 中，柄的模块化没有合理的理由。
