Safety of posterolateral approach with a polished cemented stem and a modular dual mobility implant in patients over 75 years old

IF 1.8 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI:10.1016/j.jor.2026.02.042

Cesare Meschini , Mattia Chirico , Matteo Innocenti , Giovanni Valentini , Paolo Salari , Andrea Baldini

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引用次数: 0

Abstract

Background

With increasing life expectancy, total hip arthroplasty (THA) is increasingly performed in patients over 75 years, a population at higher risk of perioperative complications. This study assessed the safety and short-to mid-term outcomes of a standardized THA strategy in elderly patients using a posterolateral approach, a polished cemented stem, and—when indicated—a modular dual mobility (DM) cup.

Methods

This retrospective multicenter study included patients >75 years who underwent primary THA with a cemented polished femoral stem and posterolateral approach (2017–2023). Group A received a modular DM cup, while Group B received a fixed-liner acetabular component. Clinical outcomes (Oxford Hip Score, VAS satisfaction) and complications were recorded. Survivorship was evaluated using Kaplan–Meier analysis in best- and worst-case scenarios.

Results

642 THAs were analyzed (Group A: 460; Group B: 182). Groups were comparable in age and sex distribution. Dislocation rate was significantly lower with DM (0.7% vs 2.75%; p = 0.045). No differences were observed in infection, aseptic loosening, periprosthetic fracture, reoperation, readmission, or mortality. Postoperative OHS was similar, while patient satisfaction (VAS) was higher in Group A (93.0 ± 7.0 vs 81.9 ± 14.2; p < 0.001). Kaplan–Meier analysis demonstrated excellent survivorship in both cohorts, without significant differences. No intraprosthetic dislocations or DM-related mechanical failures occurred.

Conclusion

THA using a posterolateral approach and a polished cemented stem is safe in patients over 75 years. Modular DM cups reduced dislocations and improved patient satisfaction without increasing complications. Their selective use may be advantageous in elderly, high-risk patients. Further prospective long-term studies are warranted.

Level of evidence

Level III, retrospective cohort study.

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75岁以上患者后外侧入路采用抛光骨水泥柄和模块化双活动种植体的安全性

随着预期寿命的增加，全髋关节置换术（THA）越来越多地用于75岁以上的患者，这一人群围手术期并发症的风险更高。本研究评估了标准化THA策略在老年患者中的安全性和中短期结果，该策略采用后外侧入路、抛光骨水泥柄和（如有需要）模块化双活动杯。方法本回顾性多中心研究纳入了75岁的经骨水泥抛光股骨干和后外侧入路行原发性THA的患者（2017-2023）。A组采用模组化DM杯，B组采用固定式髋臼假体。记录临床结果（牛津髋关节评分、VAS满意度）和并发症。在最佳和最坏情况下，使用Kaplan-Meier分析评估生存率。结果共分析THAs 642例（A组460例，B组182例）。各组在年龄和性别分布上具有可比性。脱位率明显低于DM （0.7% vs 2.75%; p = 0.045）。在感染、无菌性松动、假体周围骨折、再手术、再入院或死亡率方面没有观察到差异。A组患者术后满意度（VAS）高于对照组（93.0±7.0 vs 81.9±14.2;p < 0.001）。Kaplan-Meier分析显示两组患者的生存率都很好，没有显著差异。无假体内脱位或dm相关机械故障发生。结论对于75岁以上的患者，采用后外侧入路和抛光骨水泥干是安全的。模块化DM杯减少了脱位，提高了患者满意度，同时没有增加并发症。它们的选择性使用可能对老年、高危患者有利。进一步的前瞻性长期研究是必要的。证据水平：III级，回顾性队列研究。

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.