Zadel Nicolas, Cazorla Céline, Carricajo Anne, Neri Thomas, Farizon Frédéric, Boyer Bertrand
Chirurgie Orthopédique et Traumatologie, Centre Hospitalier du Forez, Montbrison 42600, France - Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc) de Saint Etienne, Saint-Étienne, 42270, France.
Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc) de Saint Etienne, Saint-Étienne, 42270, France - Maladies Infectieuses et Tropicales, CHU de Saint Etienne, Saint Etienne, France; Univ Jean Monnet, INSERM, CIC1408, FCRIN, I-REIVAC, RENARCI, ANRS, 42270, France.
SICOT J. 2025;11:19. doi: 10.1051/sicotj/2025013. Epub 2025 Mar 20.
The two-stage management of hip Prosthetic Joint Infection (PJI) is faced with a high rate of dislocation. Dual mobility (DM) cups have proved effective in reducing the risk of dislocation, but few data are available on the two-stage management of hip PJI. The objectives of this retrospective cohort study were to analyze the rate of dislocation, and the rate of recurrent dislocation and to identify risk factors for dislocation. Our hypothesis was that the use of a DM cup during a two-stage replacement had a low instability rate.
Data from 70 two-stage changes with DM cup reimplantation performed in our centre between 2011 and 2020 were retrospectively collated. The mean age was 69 years [18-93], with a mean follow-up of 3.4 years [1.5-9.6]. Dislocation rates and risk factors for prosthetic instability were collected. Univariate and multivariate analyses were performed to identify risk factors favouring prosthetic instability.
The rate of dislocation at the last follow-up was 8.6% (6/70), including 4.3% (3/70) in patients with no infection recurrence. The rate of recurrent dislocation was 0% when infection was controlled. The occurrence of spacer dislocation, the presence of immunosuppressive and antiaggregant medication, the local grade of the McPherson score and infection treatment failure were associated with the occurrence of a dislocation. No risk factors were identified in the multivariate analysis.
Compared with the rates reported in the literature, the use of a DM cup seems indicated in this context in order to lower the risk of recurrent dislocation. Preventing spacer dislocation and infection recurrence seems to be essential to avoid the risk of instability of the future prosthetic hip.
髋关节假体周围感染（PJI）的两阶段治疗面临着较高的脱位率。双动（DM）髋臼杯已被证明可有效降低脱位风险，但关于髋关节PJI两阶段治疗的数据较少。这项回顾性队列研究的目的是分析脱位率、再脱位率，并确定脱位的危险因素。我们的假设是，在两阶段置换过程中使用DM髋臼杯的不稳定率较低。
回顾性整理了2011年至2020年在我们中心进行的70例采用DM髋臼杯再植入的两阶段置换的数据。平均年龄为69岁[18 - 93岁]，平均随访时间为3.4年[1.5 - 9.6年]。收集脱位率和假体不稳定的危险因素。进行单因素和多因素分析以确定有利于假体不稳定的危险因素。
最后一次随访时的脱位率为8.6%（6/70），其中无感染复发患者的脱位率为4.3%（3/70）。感染得到控制时再脱位率为0%。间隔器脱位的发生、免疫抑制和抗凝血药物的使用、麦克弗森评分的局部分级以及感染治疗失败与脱位的发生有关。多因素分析未发现危险因素。
与文献报道的发生率相比，在这种情况下使用DM髋臼杯似乎有助于降低再脱位风险。预防间隔器脱位和感染复发似乎对于避免未来人工髋关节不稳定的风险至关重要。
