Dubin Jeremy A, Bains Sandeep S, Chen Zhongming, Hameed Daniel, Moore Mallory C, Mont Michael A, Nace James, Delanois Ronald E
Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
J Orthop. 2023 Jul 25;43:75-78. doi: 10.1016/j.jor.2023.07.016. eCollection 2023 Sep.
Revision total hip arthroplasty (rTHA) is at increased risk for postoperative instability when compared to primary cases, which has been mitigated to some extent with the introduction of dual mobility (DM) reconstructions. These constructs were designed to lower dislocation rates and to improve impingement-free range of motion. As a follow-up to our prior institutional study, we expanded on a cohort of DM reconstructions compared to non-DM constructs. We examined a modular dual mobility system in rTHA to measure loosening of the acetabular component, as well as revision and dislocation rates in comparison to an historical cohort of single articulation prostheses.Materials/Methods: This retrospective cohort study from a single center included 254 patients who underwent rTHA with a dual mobility liner by three fellowship-trained surgeons between January 1, 2014 and December 1, 2019. This was a follow-up to an historical cohort of revisions performed with a single articulation prosthesis (n = 120) from the same surgeons performed between January 1, 2011 and December 23, 2013. The inclusion criteria included consecutively performed rTHAs that had a minimum follow-up of 2 years. We excluded patients who had femoral revisions and head/liner revisions only. The average follow-up in the dual mobility cohort and the single articulation cohort was 5 years (range, 2-10 years) and 2.5 years (range, 1.5-4.3 years), respectively. The primary outcomes were dislocation, aseptic loosening, and re-revision rates. Secondary outcomes were radiographic analyses of cup migration and osteolysis.
There were 4 out of 256 (1.6%) dislocations from the dual mobility cohort compared to 7 out of 120 (5.8%), < 0.001 from the single articulation cohort. The rates of aseptic loosening were 3.2% (8 out of 254) and 4.2% (5 out of 120), = 0.124, respectively, between the cohorts. The re-revision rate was 5.9% for the DM liners and 8.3% in the control cohort, = 0.38. Radiographic analyses revealed no cup migration and osteolysis in any of the patients that had no dislocations.
The dual mobility articulations in rTHA demonstrated improved results in terms of lower dislocations rates when compared to a single articulation prostheses. Our center uses these articulations for revisions and surgeons should consider the use of these bearings when performing rTHA.
与初次全髋关节置换术相比，翻修全髋关节置换术（rTHA）术后不稳定的风险增加，而双动（DM）重建技术的引入在一定程度上缓解了这一问题。这些结构旨在降低脱位率并改善无撞击活动范围。作为我们之前机构研究的后续，我们扩大了一组DM重建与非DM结构的对比研究。我们研究了rTHA中的一种模块化双动系统，以测量髋臼组件的松动情况，以及与单关节假体的历史队列相比的翻修率和脱位率。
材料/方法：这项来自单一中心的回顾性队列研究纳入了254例患者，他们在2014年1月1日至2019年12月1日期间由三位接受过专科培训的外科医生进行了带双动衬垫的rTHA手术。这是对同一外科医生在2011年1月1日至2013年12月23日期间进行的单关节假体翻修历史队列（n = 一百二十）的随访。纳入标准包括连续进行的rTHA，且至少随访2年。我们排除了仅进行股骨翻修和股骨头/衬垫翻修的患者。双动队列和单关节队列的平均随访时间分别为5年（范围2 - 10年）和2.5年（范围1.5 - 4.3年）。主要结局指标为脱位、无菌性松动和再次翻修率。次要结局指标为髋臼移位和骨溶解的影像学分析。
双动队列中256例中有4例（1.6%）发生脱位，而单关节队列中120例中有7例（5.8%）发生脱位，两者相比，P < 0.001。队列之间无菌性松动率分别为3.2%（254例中的8例）和4.2%（120例中的5例），P = 0.124。DM衬垫的再次翻修率为5.9%，对照组为8.3%，P = 0.38。影像学分析显示，在未发生脱位的患者中均未发现髋臼移位和骨溶解。
与单关节假体相比，rTHA中的双动关节在降低脱位率方面显示出更好的结果。我们中心在翻修手术中使用这些关节，外科医生在进行rTHA时应考虑使用这些轴承。
