Popa Codrin, Le Baron Marie, Dobelle Émile, Flecher Xavier, Prost Solène, Ollivier Matthieu, Argenson Jean-Noel, Jacquet Christophe
Institute of Movement and Locomotion, Department of Orthopaedics and Traumatology, Sainte-Marguerite Hospital, Marseille, France.
Institute for Locomotion, Department of Orthopedics and Traumatology, Northern Hospital, Marseille, France.
Bone Joint J. 2025 Feb 1;107-B(2):164-172. doi: 10.1302/0301-620X.107B2.BJJ-2024-0749.R2.
The aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality.
Data were retrospectively analyzed from a continuously gathered database. We included 150 revisions, performed between January 2015 and December 2022, in 150 patients, with 81 revisions limited to only the femoral component and 69 involving revision of both components. This resulted, after surgery, in 60 patients having a simple-mobility acetabular component and 90 having a dual-mobility component. The mean age of the patients was 79.7 years (SD 10.1), and 98 were female (65.3%). The mean follow-up was 31 months (SD 2.3).
There were no significant differences between those in whom only the femoral component was revised and those in whom both components were revised with the use of a dual-mobility acetabular component for the rate of intraoperative complications, postoperative mortality, blood loss, the requirement of a blood transfusion, medical complications, dislocation (11/81 in the femoral component-only group vs 6/69 in the femoral + acetabular component revision group) or the overall need for reoperation at the final follow-up. Patients were at a significantly higher risk for dislocation when a simple-mobility component was retained (18.3% (n = 11) vs 6.7% (n = 6) for dual-mobility implants; p = 0.036). The revision rate prompted by postoperative instability was significantly higher in patients in whom a simple-mobility acetabular component was retained at revision (10% (n = 6) vs 0%; p = 0.002).
Based on these results, concurrent revision of the acetabular component was not associated with a higher rate of mortality or increased morbidity and patients in whom a dual-mobility acetabular component was used were significantly less prone to dislocation. We thus recommend routine revision of the acetabular component in favour of a dual-mobility component for patients sustaining a Vancouver B2 PFF requiring revision of the femoral component if their initial THA included a simple-mobility acetabular component.
本研究旨在评估对于需要翻修股骨组件的温哥华B2型假体周围股骨骨折（PFF）患者，在翻修全髋关节置换术（THA）时翻修髋臼组件的必要性。假设是同时翻修髋臼和股骨组件并使用双动髋臼组件将降低术后脱位风险，且不会增加围手术期发病率和死亡率。
对一个持续收集的数据库中的数据进行回顾性分析。我们纳入了2015年1月至2022年12月期间对150例患者进行的150次翻修手术，其中81次仅翻修股骨组件，69次涉及两个组件的翻修。术后，60例患者使用单动髋臼组件，90例使用双动组件。患者的平均年龄为79.7岁（标准差10.1），98例为女性（65.3%）。平均随访时间为31个月（标准差2.3）。
仅翻修股骨组件的患者与同时翻修两个组件并使用双动髋臼组件的患者在术中并发症发生率、术后死亡率、失血量、输血需求、医疗并发症、脱位（仅翻修股骨组件组为11/81，股骨 + 髋臼组件翻修组为6/69）或最后随访时再次手术的总体需求方面无显著差异。保留单动组件时患者脱位风险显著更高（双动植入物为6.7%（n = 6），单动组件为18.3%（n = 11）；p = 0.036）。翻修时保留单动髋臼组件的患者因术后不稳定导致的翻修率显著更高（10%（n = 6）对0%；p = 0.002）。
基于这些结果，髋臼组件的同时翻修与更高的死亡率或发病率增加无关，并且使用双动髋臼组件的患者脱位倾向显著更低。因此，我们建议对于因初始THA包含单动髋臼组件而发生温哥华B2型PFF且需要翻修股骨组件的患者，常规翻修髋臼组件并使用双动组件。
