{"title":"使用非交联聚乙烯的第三代双活动度全髋关节置换术在 60 岁以下患者中的效果:8.6 年后全压入式与三脚架杯的比较研究。","authors":"","doi":"10.1016/j.otsr.2024.103934","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>The concept of dual mobility of total hip arthroplasties<span> (THA) is a revolution in the prevention of dislocations and in the treatment of instability. Its use remains controversial in patients under 60 years old, providing poorer results with first generation cups coated with alumina. This study, carried out on modern dual mobility (DM) cups with a porous bilayer coating, in active patients under 60 years of age aimed to evaluate: (1) the mechanical survival of two latest generation DM THA, with failure defined as revision of acetabular or femoral implants for mechanical loosening, by comparing a tripod cup to a full pressfit cup, (2) to evaluate the complications, (3) to compare the rate of radiographic peri-prosthetic </span></span>osteolysis between the 2 implants.</p></div><div><h3>Hypothesis</h3><p>The hypothesis was that the medium-term survival of modern DM cups placed in young patients was the same regardless of the type of acetabular fixation used.</p></div><div><h3>Materials and methods</h3><p><span>This was a retrospective study of 119 latest generation DM THA with standard polyethylene, composed of 66 full pressfit cups and 53 tripod fixation cups, used in primary arthroplasty<span><span> in 111 patients between 2005 and 2016. The survival study was carried out using medical records. The </span>clinical evaluation<span> was carried out using the modified Harris Hip Score (mHHS) as well as the self-administered Hip and </span></span></span>Osteoarthritis<span> Outcome Score (HOOS) and Oxford-12 questionnaires. Radiological analysis was carried out on radiographs looking for bone demineralization and acetabular and femoral lines.</span></p></div><div><h3>Results</h3><p>At 8.6 years (5–16), no revision for mechanical loosening was observed regardless of the type of cup. The prosthesis dislocation<span> rate (large joint) was 1.7%: 1 case in each group (p = 1), including one revision required in the full pressfit group. Three revisions for mechanical complications were recorded: a recurrent dislocating hip on a full pressfit cup that was not sufficiently anteverted, an acetabular peri-prosthetic fracture on a full pressfit cup and a case of iliopsoas impingement with a retroverted tripod cup. The survival rate for all-cause revision was 93.8% for pressfit (95% CI: 88.2%–99.9%) vs. 96.2% for tripod (95% CI: 91.1%–100%) (p = 0.63) and for revision due to any cause excluding infection, 96.9% for pressfit (95% CI: 92.8%–100%) vs. 98.1% for tripod (95% CI: 94.4%–100%) (p = 0.7). The rate of periacetabular osteolysis was 11%, significantly more present amongst tripod cups (24%, 9 cases) compared to full pressfit cups (2%, 1 case) (p < 0.01).</span></p></div><div><h3>Conclusion</h3><p>This series demonstrates good performance of 3rd generation DM cups with porous bilayer coating in patients under 60 years of age regardless of the type of acetabular fixation, at 8.6 years of follow-up. The rate of osteolysis around full pressfit cups remains very low, unlike that of tripod cups. The use of Double Mobility prostheses for primary hip osteoarthritis is possible in young patients, preferably with full pressfit cups (i.e., without any pegs or additional screws that may promote diffusion of polyethylene debris and osteolysis).</p></div><div><h3>Level of evidence</h3><p>III; comparative retrospective study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Results of third generation dual mobility total hip arthroplasties with non-cross-linked polyethylene in patients under 60 years of age: comparative study of full pressfit vs. tripod cups after 8.6 years\",\"authors\":\"\",\"doi\":\"10.1016/j.otsr.2024.103934\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>The concept of dual mobility of total hip arthroplasties<span> (THA) is a revolution in the prevention of dislocations and in the treatment of instability. Its use remains controversial in patients under 60 years old, providing poorer results with first generation cups coated with alumina. This study, carried out on modern dual mobility (DM) cups with a porous bilayer coating, in active patients under 60 years of age aimed to evaluate: (1) the mechanical survival of two latest generation DM THA, with failure defined as revision of acetabular or femoral implants for mechanical loosening, by comparing a tripod cup to a full pressfit cup, (2) to evaluate the complications, (3) to compare the rate of radiographic peri-prosthetic </span></span>osteolysis between the 2 implants.</p></div><div><h3>Hypothesis</h3><p>The hypothesis was that the medium-term survival of modern DM cups placed in young patients was the same regardless of the type of acetabular fixation used.</p></div><div><h3>Materials and methods</h3><p><span>This was a retrospective study of 119 latest generation DM THA with standard polyethylene, composed of 66 full pressfit cups and 53 tripod fixation cups, used in primary arthroplasty<span><span> in 111 patients between 2005 and 2016. The survival study was carried out using medical records. The </span>clinical evaluation<span> was carried out using the modified Harris Hip Score (mHHS) as well as the self-administered Hip and </span></span></span>Osteoarthritis<span> Outcome Score (HOOS) and Oxford-12 questionnaires. Radiological analysis was carried out on radiographs looking for bone demineralization and acetabular and femoral lines.</span></p></div><div><h3>Results</h3><p>At 8.6 years (5–16), no revision for mechanical loosening was observed regardless of the type of cup. The prosthesis dislocation<span> rate (large joint) was 1.7%: 1 case in each group (p = 1), including one revision required in the full pressfit group. Three revisions for mechanical complications were recorded: a recurrent dislocating hip on a full pressfit cup that was not sufficiently anteverted, an acetabular peri-prosthetic fracture on a full pressfit cup and a case of iliopsoas impingement with a retroverted tripod cup. The survival rate for all-cause revision was 93.8% for pressfit (95% CI: 88.2%–99.9%) vs. 96.2% for tripod (95% CI: 91.1%–100%) (p = 0.63) and for revision due to any cause excluding infection, 96.9% for pressfit (95% CI: 92.8%–100%) vs. 98.1% for tripod (95% CI: 94.4%–100%) (p = 0.7). The rate of periacetabular osteolysis was 11%, significantly more present amongst tripod cups (24%, 9 cases) compared to full pressfit cups (2%, 1 case) (p < 0.01).</span></p></div><div><h3>Conclusion</h3><p>This series demonstrates good performance of 3rd generation DM cups with porous bilayer coating in patients under 60 years of age regardless of the type of acetabular fixation, at 8.6 years of follow-up. The rate of osteolysis around full pressfit cups remains very low, unlike that of tripod cups. The use of Double Mobility prostheses for primary hip osteoarthritis is possible in young patients, preferably with full pressfit cups (i.e., without any pegs or additional screws that may promote diffusion of polyethylene debris and osteolysis).</p></div><div><h3>Level of evidence</h3><p>III; comparative retrospective study.</p></div>\",\"PeriodicalId\":54664,\"journal\":{\"name\":\"Orthopaedics & Traumatology-Surgery & Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedics & Traumatology-Surgery & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1877056824001907\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1877056824001907","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Results of third generation dual mobility total hip arthroplasties with non-cross-linked polyethylene in patients under 60 years of age: comparative study of full pressfit vs. tripod cups after 8.6 years
Background
The concept of dual mobility of total hip arthroplasties (THA) is a revolution in the prevention of dislocations and in the treatment of instability. Its use remains controversial in patients under 60 years old, providing poorer results with first generation cups coated with alumina. This study, carried out on modern dual mobility (DM) cups with a porous bilayer coating, in active patients under 60 years of age aimed to evaluate: (1) the mechanical survival of two latest generation DM THA, with failure defined as revision of acetabular or femoral implants for mechanical loosening, by comparing a tripod cup to a full pressfit cup, (2) to evaluate the complications, (3) to compare the rate of radiographic peri-prosthetic osteolysis between the 2 implants.
Hypothesis
The hypothesis was that the medium-term survival of modern DM cups placed in young patients was the same regardless of the type of acetabular fixation used.
Materials and methods
This was a retrospective study of 119 latest generation DM THA with standard polyethylene, composed of 66 full pressfit cups and 53 tripod fixation cups, used in primary arthroplasty in 111 patients between 2005 and 2016. The survival study was carried out using medical records. The clinical evaluation was carried out using the modified Harris Hip Score (mHHS) as well as the self-administered Hip and Osteoarthritis Outcome Score (HOOS) and Oxford-12 questionnaires. Radiological analysis was carried out on radiographs looking for bone demineralization and acetabular and femoral lines.
Results
At 8.6 years (5–16), no revision for mechanical loosening was observed regardless of the type of cup. The prosthesis dislocation rate (large joint) was 1.7%: 1 case in each group (p = 1), including one revision required in the full pressfit group. Three revisions for mechanical complications were recorded: a recurrent dislocating hip on a full pressfit cup that was not sufficiently anteverted, an acetabular peri-prosthetic fracture on a full pressfit cup and a case of iliopsoas impingement with a retroverted tripod cup. The survival rate for all-cause revision was 93.8% for pressfit (95% CI: 88.2%–99.9%) vs. 96.2% for tripod (95% CI: 91.1%–100%) (p = 0.63) and for revision due to any cause excluding infection, 96.9% for pressfit (95% CI: 92.8%–100%) vs. 98.1% for tripod (95% CI: 94.4%–100%) (p = 0.7). The rate of periacetabular osteolysis was 11%, significantly more present amongst tripod cups (24%, 9 cases) compared to full pressfit cups (2%, 1 case) (p < 0.01).
Conclusion
This series demonstrates good performance of 3rd generation DM cups with porous bilayer coating in patients under 60 years of age regardless of the type of acetabular fixation, at 8.6 years of follow-up. The rate of osteolysis around full pressfit cups remains very low, unlike that of tripod cups. The use of Double Mobility prostheses for primary hip osteoarthritis is possible in young patients, preferably with full pressfit cups (i.e., without any pegs or additional screws that may promote diffusion of polyethylene debris and osteolysis).
期刊介绍:
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.