Département de Chirurgie Orthopédique du CHU de Caen Unité Inserm Comete 1075, Av. de la Côte de Nacre, 14000 Caen, France.
Département de Chirurgie Orthopédique du CHU de Caen Unité Inserm Comete 1075, Av. de la Côte de Nacre, 14000 Caen, France.
Orthop Traumatol Surg Res. 2024 Oct;110(6):103934. doi: 10.1016/j.otsr.2024.103934. Epub 2024 Jul 10.
The concept of dual mobility of total hip arthroplasties (THA) is a revolution in the prevention of dislocations and in the treatment of instability. Its use remains controversial in patients under 60 years old, providing poorer results with first generation cups coated with alumina. This study, carried out on modern dual mobility (DM) cups with a porous bilayer coating, in active patients under 60 years of age aimed to evaluate: (1) the mechanical survival of two latest generation DM THA, with failure defined as revision of acetabular or femoral implants for mechanical loosening, by comparing a tripod cup to a full pressfit cup, (2) to evaluate the complications, (3) to compare the rate of radiographic peri-prosthetic osteolysis between the 2 implants.
The hypothesis was that the medium-term survival of modern DM cups placed in young patients was the same regardless of the type of acetabular fixation used.
This was a retrospective study of 119 latest generation DM THA with standard polyethylene, composed of 66 full pressfit cups and 53 tripod fixation cups, used in primary arthroplasty in 111 patients between 2005 and 2016. The survival study was carried out using medical records. The clinical evaluation was carried out using the modified Harris Hip Score (mHHS) as well as the self-administered Hip and Osteoarthritis Outcome Score (HOOS) and Oxford-12 questionnaires. Radiological analysis was carried out on radiographs looking for bone demineralization and acetabular and femoral lines.
At 8.6 years (5-16), no revision for mechanical loosening was observed regardless of the type of cup. The prosthesis dislocation rate (large joint) was 1.7%: 1 case in each group (p = 1), including one revision required in the full pressfit group. Three revisions for mechanical complications were recorded: a recurrent dislocating hip on a full pressfit cup that was not sufficiently anteverted, an acetabular peri-prosthetic fracture on a full pressfit cup and a case of iliopsoas impingement with a retroverted tripod cup. The survival rate for all-cause revision was 93.8% for pressfit (95% CI: 88.2%-99.9%) vs. 96.2% for tripod (95% CI: 91.1%-100%) (p = 0.63) and for revision due to any cause excluding infection, 96.9% for pressfit (95% CI: 92.8%-100%) vs. 98.1% for tripod (95% CI: 94.4%-100%) (p = 0.7). The rate of periacetabular osteolysis was 11%, significantly more present amongst tripod cups (24%, 9 cases) compared to full pressfit cups (2%, 1 case) (p < 0.01).
This series demonstrates good performance of 3rd generation DM cups with porous bilayer coating in patients under 60 years of age regardless of the type of acetabular fixation, at 8.6 years of follow-up. The rate of osteolysis around full pressfit cups remains very low, unlike that of tripod cups. The use of Double Mobility prostheses for primary hip osteoarthritis is possible in young patients, preferably with full pressfit cups (i.e., without any pegs or additional screws that may promote diffusion of polyethylene debris and osteolysis).
III; comparative retrospective study.
全髋关节置换术（THA）双动概念是预防脱位和不稳定的一项革命。在 60 岁以下的患者中，第一代涂氧化铝的双动杯仍存在争议，其结果较差。本研究针对现代双动（DM）杯（双层多孔涂层）在 60 岁以下活跃患者中的应用，旨在评估：（1）比较三脚架杯和全压配杯，两种最新一代 DM THA 的机械生存率，以因机械松动而翻修髋臼或股骨植入物为失败定义；（2）评估并发症；（3）比较两种植入物的影像学假体周围溶骨性。
无论使用何种髋臼固定方式，现代 DM 杯在年轻患者中的中期生存率均相同。
这是一项回顾性研究，纳入 2005 年至 2016 年间 111 例患者的 119 例最新一代 DM THA，采用标准聚乙烯，其中 66 例全压配杯，53 例三脚架固定杯。初次关节置换术中使用。通过病历进行生存研究。使用改良 Harris 髋关节评分（mHHS）以及自我管理的髋关节和骨关节炎结果评分（HOOS）和牛津-12 问卷进行临床评估。在影像学上观察骨脱矿质和髋臼及股骨线，进行影像学分析。
8.6 年（5-16 年）时，无论杯的类型如何，均未观察到因机械松动而进行的翻修。大关节假体脱位率为 1.7%：每组各 1 例（p=1），包括全压配杯组中 1 例需要翻修。记录了 3 例因机械并发症而进行的翻修：1 例全压配杯髋臼假体周围骨折，1 例全压配杯因复发性脱位需要翻修，1 例因逆行三脚架杯而发生髂腰肌撞击。全因翻修的生存率为压配杯 93.8%（95%CI：88.2%-99.9%），三脚架杯 96.2%（95%CI：91.1%-100%）（p=0.63），因任何原因（不包括感染）翻修的生存率为压配杯 96.9%（95%CI：92.8%-100%），三脚架杯 98.1%（95%CI：94.4%-100%）（p=0.7）。髋臼周围溶骨性的发生率为 11%，三脚架杯（24%，9 例）明显高于全压配杯（2%，1 例）（p<0.01）。
本研究表明，在 8.6 年的随访中，第三代 DM 杯（双层多孔涂层）在 60 岁以下患者中具有良好的性能，无论髋臼固定方式如何。全压配杯周围的溶骨性发生率仍非常低，与三脚架杯不同。对于年轻患者，可使用双动假体治疗原发性髋关节骨关节炎，优选全压配杯（即无任何销钉或附加螺钉，可促进聚乙烯碎片和溶骨性扩散）。
III；比较回顾性研究。
