背景:双活动髋臼杯(DMC)旨在增加有效的股骨头尺寸并提高稳定性,目的是以聚乙烯厚度的潜在成本降低翻修风险。与高度交联聚乙烯(XLPE)相比,我们试图评估使用DMC进行初次选择性全髋关节置换术(THA)后的翻修风险。
方法:使用来自美国(US)综合医疗保健系统的全关节置换术登记的数据进行了一项队列研究。≥18岁的患者接受了使用DMC的主要选择性THA,单极XLPE金属(MoXLPE),或确定了单极XLPE陶瓷(CoXLPE)(2010年至2021年)。最终样品包括2,219个DMC,48,251MoXLPE,和57,058CoXLPE。使用多个Cox比例风险回归评估6年随访内的无菌翻修和6年内的任何脱位,无论翻修如何,使用DMC作为参考组和混杂调整。
结果:在调整后的分析中,与DMC相比,MoXLPE(风险比[HR]=1.04,95%置信区间[CI]=0.72~1.51)或CoXLPE(HR=0.98,95%CI=0.69~1.40)的无菌翻修风险无差异.在调整后的分析中,与DMC相比,MoXLPE(HR=1.42,95%CI=0.93~2.15)或CoXLPE(HR=1.25,95%CI=0.84~1.87)的脱位风险没有差异.
结论:在一个美国队列中,DMC的6年无菌翻修风险与金属或陶瓷股骨头单极结构相似。此外,在脱位风险方面没有观察到差异.对我们的队列进行持续的长期随访可能会揭示是否存在以增加后期修订为代价的脱位风险降低。
BACKGROUND: Dual mobility acetabular cups (DMC) were designed to increase the effective femoral head size and improve stability with the goal of reducing revision risk at the potential cost of polyethylene thickness. We sought to evaluate revision risk following primary elective total hip arthroplasty with DMC compared to highly cross-linked polyethylene (XLPE).
METHODS: A cohort study was conducted using data from a Kaiser Permanente\'s total joint arthroplasty registry. Patients ≥18 years who underwent primary elective total hip arthroplasty using DMC, unipolar Metal-on-XLPE (MoXLPE), or unipolar Ceramic-on-XLPE (CoXLPE) were identified (2010 to 2021). The final sample comprised 2,219 DMC, 48,251 MoXLPE, and 57,058 CoXLPE. Multiple Cox proportional hazard regressions were used to evaluate aseptic revision and any dislocation regardless of revision within 6 years follow-up.
RESULTS: In adjusted analyses, no differences in aseptic revision risk were observed for MoXLPE (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.72 to 1.51) or CoXLPE (HR = 0.98, 95% CI = 0.69 to 1.40) compared to DMC. No differences in dislocation risk were observed for MoXLPE (HR = 1.42, 95% CI = 0.93 to 2.15) or CoXLPE (HR = 1.25, 95% CI = 0.84 to 1.87) compared to DMC.
CONCLUSIONS: In a US-based cohort, 6-year aseptic revision risk of DMC was similar to metal or ceramic femoral head unipolar constructs. Furthermore, no difference in dislocation risk was observed. Continued longer-term follow-up may reveal if there is a reduced risk of dislocation that comes at the cost of increased late revision.
METHODS: Level III.