■全髋关节置换术(THA)是一种常见且成功的手术。然而,脱位仍然是固定轴承设计中植入物失败的重要原因。这项研究调查了双动植入物(DM)与固定轴承(FB)植入物相比对全因修正的影响,由于错位而进行的修订,接受原发性和翻修THA的患者的术后并发症和功能评分。
■进行了系统评价,包括根据PRISMA指南将DM与FB植入物在初级或修订THA中进行比较的研究。并在PROSPERO注册(IDCRD42023403736)。科克伦图书馆,Embase,MEDLINE,WebofScience,和Scopus从数据库开始到2023年3月12日进行了搜索。符合条件的研究使用ROBINS-I工具进行荟萃分析和偏倚风险评估。使用比值比评估治疗效果,并使用随机效应最大似然法汇总数据,在适当的地方。
■八个比较,纳入了涉及2810例DM植入物和3188例FB植入物的非随机研究.在初级THA中,对全因翻修的差异估计不准确(OR0.82,95%CI0.25~2.72),对糖尿病队列的脱位翻修有显著获益(OR0.08,95%CI0.02~0.28).在修订版THA中,DM队列在全因翻修(OR0.57,95%CI0.31-1.05)和脱位翻修(OR0.14,95%CI0.04-0.53)方面显示获益.DM植入物与较低的植入物脱位和感染发生率相关。由于报告限制,对功能结果的分析受到限制。未观察到假体内脱位。
■结果表明,当代DM设计可能有利于降低全因修订的风险,由于脱位而导致的翻修,以及中期随访时的术后并发症发生率。需要进一步的高质量前瞻性研究来评估这种设计的长期风险状况。特别是在修订的背景下。
UNASSIGNED: Total hip arthroplasty (THA) is a common and successful operation. However,
dislocation remains a significant cause of implant failure in fixed-bearing designs. This study investigated the effect of dual-mobility implants (DM) compared to fixed-bearing (FB) implants on all-cause revisions, revisions due to
dislocation, post-operative complications and functional scores in patients undergoing primary and revision THA.
UNASSIGNED: A systematic review was performed including studies that compared DM with FB implants in primary or revision THA according to PRISMA guidelines, and was registered in PROSPERO (ID CRD42023403736). The Cochrane Library, Embase, MEDLINE, Web of Science, and Scopus were searched from the time of database inception to March 12, 2023. Eligible studies underwent meta-analysis and risk of bias assessment using the ROBINS-I tool. Treatment effects were assessed using odds ratios and data were pooled using a random-effects maximum-likelihood, where appropriate.
UNASSIGNED: Eight comparative, non-randomised studies involving 2810 DM implants and 3188 FB implants were included. In primary THA, there was an imprecise estimate of the difference in all-cause revision (OR 0.82, 95 % CI 0.25-2.72) and a significant benefit for the DM cohort in revision due to
dislocation (OR 0.08, 95 % CI 0.02-0.28). In revision THA, the DM cohort showed benefit in all-cause revision (OR 0.57, 95 % CI 0.31-1.05) and revision due to
dislocation (OR 0.14, 95 % CI 0.04-0.53). DM implants were associated with a lower incidence of implant
dislocation and infection. The analysis of functional outcomes was limited due to reporting limitations. No intraprosthetic dislocations were observed.
UNASSIGNED: The results suggest that contemporary DM designs may be advantageous in reducing the risk of all-cause revision, revision due to dislocation, and post-operative complication incidence at mid-term follow-up. Further high-quality prospective studies are needed to evaluate the long-term risk profile of this design, especially in the revision context.