Department of Orthopedic Surgery, NYU Langone Hospital - Long Island, Mineola, New York.
NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York.
J Arthroplasty. 2023 Jul;38(7S):S136-S141. doi: 10.1016/j.arth.2023.04.008. Epub 2023 Apr 15.
Selective use of dual mobility (DM) implants in total hip arthroplasty (THA) patients at high dislocation risk has been proposed. However, evidence-based utilization thresholds have not been defined. We explored whether surgeon-specific rates of DM utilization correlate with rates of readmission and reoperation for dislocation.
We retrospectively reviewed 14,818 primary THA procedures performed at a single institution between 2011 and 2021, including 14,310 fixed-bearing (FB) and 508 DM implant constructs. Outcomes including 90-day readmissions and reoperations were compared between patients who had FB and DM implants. Cases were then stratified into 3 groups based on the attending surgeon's rate of DM utilization (≤ 1, 1 to 10, or > 10%) and outcomes were compared.
There were no differences in 90-day outcomes between FB and DM implant groups. Surgeon frequency of DM utilization ranged from 0% to 43%. There were 48 surgeons (73%) who used DM in ≤ 1% of cases, 11 (17%) in 1% to 10% of cases, and 7 (10%) in > 10% of cases. The 90-day rates of readmission (7.3% versus 7.6% versus 7.2%, P = .7) and reoperation (3.4% versus 3.9% versus 3.8%, P = .3), as well as readmission for instability (0.5% versus 0.6% versus 0.8%, P = .2) and reoperation for instability (0.5% versus 0.5% versus 0.8%, P = .6), did not statistically differ between cohorts.
Selective DM utilization did not reduce 90-day readmissions or reoperations following primary THA. Other dislocation-mitigation strategies (ie, surgical approach, computer navigation, robotic assistance, and large diameter FBs) may have masked any benefits of selective DM use.
在髋关节置换术（THA）高脱位风险患者中，选择性使用双动（DM）植入物已被提出。然而，基于证据的使用阈值尚未确定。我们探讨了外科医生特异性 DM 使用率是否与脱位再入院和再手术率相关。
我们回顾性分析了 2011 年至 2021 年期间在一家机构进行的 14818 例初次 THA 手术，包括 14310 例固定轴承（FB）和 508 例 DM 植入物。比较了 FB 和 DM 植入物患者的 90 天再入院和再手术的结果。然后根据主治医生的 DM 使用率（≤1%、1%至 10%或>10%）将病例分为 3 组，比较结果。
FB 和 DM 植入组在 90 天的结果无差异。外科医生 DM 使用频率从 0%到 43%不等。有 48 名外科医生（73%）在≤1%的病例中使用 DM，11 名（17%）在 1%至 10%的病例中使用，7 名（10%）在>10%的病例中使用。90 天的再入院率（7.3%比 7.6%比 7.2%，P=0.7）和再手术率（3.4%比 3.9%比 3.8%，P=0.3），以及不稳定再入院率（0.5%比 0.6%比 0.8%，P=0.2）和不稳定再手术率（0.5%比 0.5%比 0.8%，P=0.6）在不同组间无统计学差异。
选择性 DM 使用并未降低初次 THA 后 90 天的再入院或再手术率。其他降低脱位风险的策略（即手术入路、计算机导航、机器人辅助和大直径 FB）可能掩盖了选择性 DM 使用的任何益处。
