Christopher N Carender, Nicholas A Bedard, Kristin M Fruth, Michael J Taunton, Mark W Pagnano, Matthew P Abdel
{"title":"在299例全髋关节置换术中期随访中，模块化双活动结构优于大股骨头。","authors":"Christopher N Carender, Nicholas A Bedard, Kristin M Fruth, Michael J Taunton, Mark W Pagnano, Matthew P Abdel","doi":"10.1302/0301-620X.107B1.BJJ-2024-0170.R1","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The purpose of this study was to directly compare the Modular Dual Mobility (MDM) Mobile Bearing Hip System (Stryker, USA) and large femoral heads (LFHs) in revision total hip arthroplasties (THAs) at mid-term follow-up, with specific emphasis on survival free of re-revision for dislocation, any re-revision, dislocation, and the risk of metal-related complications.</p><p><strong>Methods: </strong>We identified 299 revision THAs performed at a single tertiary care academic institution from March 2011 to July 2014. Aseptic loosening of the acetabular component (n = 65), dislocation (n = 58), and reimplantation as part of a two-stage exchange protocol (n = 57) were the most common reasons for index revision. MDM constructs were used in 123 cases, and LFHs were used in 176 cases. Mean age was 66 years (28 to 93), mean BMI was 31 kg/m<sup>2</sup> (18 to 55), and 45% (n = 136) were female. Mean follow-up was seven years (2 to 12).</p><p><strong>Results: </strong>The ten-year survival free of re-revision for dislocation was 99% (95% CI 95 to 100) in the MDM cohort and 91% (95% CI 84 to 96) in the LFH cohort, with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 7.1 (95% CI 1.3 to 40.8); p = 0.023). The ten-year survival free of any re-revision was 92% (95% CI 82 to 99%) in the MDM cohort and 84% (95% CI 74 to 90) in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.6 (95% CI 1.1 to 5.9); p = 0.024). The ten-year survival free of any dislocation was 95% (95% CI 85 to 99) in the MDM cohort and 87% (95% CI 78 to 92) in the LFH cohort with a significantly increased risk of any dislocation in the LFH cohort (HR 2.7 (95% CI 1.1 to 6.3); p = 0.028). There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.</p><p><strong>Conclusion: </strong>In this head-to-head comparison, revision THAs with a MDM construct safely and effectively lowered the risk of re-revision for dislocation, any re-revision, and any dislocation compared to LFH at mid-term follow-up. There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"107-B 1","pages":"58-64"},"PeriodicalIF":4.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Modular dual-mobility constructs outperformed large femoral heads in 299 revision total hip arthroplasties at mid-term follow-up.\",\"authors\":\"Christopher N Carender, Nicholas A Bedard, Kristin M Fruth, Michael J Taunton, Mark W Pagnano, Matthew P Abdel\",\"doi\":\"10.1302/0301-620X.107B1.BJJ-2024-0170.R1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The purpose of this study was to directly compare the Modular Dual Mobility (MDM) Mobile Bearing Hip System (Stryker, USA) and large femoral heads (LFHs) in revision total hip arthroplasties (THAs) at mid-term follow-up, with specific emphasis on survival free of re-revision for dislocation, any re-revision, dislocation, and the risk of metal-related complications.</p><p><strong>Methods: </strong>We identified 299 revision THAs performed at a single tertiary care academic institution from March 2011 to July 2014. Aseptic loosening of the acetabular component (n = 65), dislocation (n = 58), and reimplantation as part of a two-stage exchange protocol (n = 57) were the most common reasons for index revision. MDM constructs were used in 123 cases, and LFHs were used in 176 cases. Mean age was 66 years (28 to 93), mean BMI was 31 kg/m<sup>2</sup> (18 to 55), and 45% (n = 136) were female. Mean follow-up was seven years (2 to 12).</p><p><strong>Results: </strong>The ten-year survival free of re-revision for dislocation was 99% (95% CI 95 to 100) in the MDM cohort and 91% (95% CI 84 to 96) in the LFH cohort, with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 7.1 (95% CI 1.3 to 40.8); p = 0.023). The ten-year survival free of any re-revision was 92% (95% CI 82 to 99%) in the MDM cohort and 84% (95% CI 74 to 90) in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.6 (95% CI 1.1 to 5.9); p = 0.024). The ten-year survival free of any dislocation was 95% (95% CI 85 to 99) in the MDM cohort and 87% (95% CI 78 to 92) in the LFH cohort with a significantly increased risk of any dislocation in the LFH cohort (HR 2.7 (95% CI 1.1 to 6.3); p = 0.028). There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.</p><p><strong>Conclusion: </strong>In this head-to-head comparison, revision THAs with a MDM construct safely and effectively lowered the risk of re-revision for dislocation, any re-revision, and any dislocation compared to LFH at mid-term follow-up. There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.</p>\",\"PeriodicalId\":48944,\"journal\":{\"name\":\"Bone & Joint Journal\",\"volume\":\"107-B 1\",\"pages\":\"58-64\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-0170.R1\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.107B1.BJJ-2024-0170.R1","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究的目的是在中期随访中直接比较模块化双活动（MDM）移动轴承髋关节系统（Stryker， USA）和大股骨头（LFHs）在翻修全髋关节置换术（tha）中的应用，特别强调无脱位重新翻修、任何重新翻修、脱位以及金属相关并发症风险的生存。方法：我们选取了2011年3月至2014年7月在一家三级医疗学术机构进行的299例tha修订。髋臼假体无菌性松动（n = 65）、脱位（n = 58）和作为两阶段交换方案的一部分重新植入术（n = 57）是指数翻修的最常见原因。123例使用MDM结构，176例使用LFHs。平均年龄66岁（28 ~ 93岁），平均BMI为31 kg/m2（18 ~ 55岁），女性占45% （n = 136）。平均随访7年（2 ~ 12年）。结果：MDM队列中脱位再次翻修的10年生存率为99% (95% CI 95 ~ 100)， LFH队列中脱位再次翻修的10年生存率为91% (95% CI 84 ~ 96)， LFH队列中脱位再次翻修的风险显著增加(HR 7.1 (95% CI 1.3 ~ 40.8)；P = 0.023)。无任何重新修订的10年生存率在MDM队列中为92% (95% CI 82 - 99%)，在LFH队列中为84% (95% CI 74 - 90)， LFH队列中任何重新修订的风险显著增加(HR 2.6 (95% CI 1.1 - 5.9)；P = 0.024)。MDM组无脱位的10年生存率为95% (95% CI 85 ~ 99)， LFH组为87% (95% CI 78 ~ 92)， LFH组脱位的风险显著增加(HR 2.7 (95% CI 1.1 ~ 6.3)；P = 0.028)。在MDM队列中，没有因金属病或腐蚀而重新修订或再次手术。结论：在这个头对头的比较中，与LFH中期随访相比，使用MDM结构的tha翻修安全有效地降低了因脱位而再次翻修的风险，任何重新翻修的风险以及任何脱位的风险。在MDM队列中，没有因金属病或腐蚀而重新修订或再次手术。
Modular dual-mobility constructs outperformed large femoral heads in 299 revision total hip arthroplasties at mid-term follow-up.
Aims: The purpose of this study was to directly compare the Modular Dual Mobility (MDM) Mobile Bearing Hip System (Stryker, USA) and large femoral heads (LFHs) in revision total hip arthroplasties (THAs) at mid-term follow-up, with specific emphasis on survival free of re-revision for dislocation, any re-revision, dislocation, and the risk of metal-related complications.
Methods: We identified 299 revision THAs performed at a single tertiary care academic institution from March 2011 to July 2014. Aseptic loosening of the acetabular component (n = 65), dislocation (n = 58), and reimplantation as part of a two-stage exchange protocol (n = 57) were the most common reasons for index revision. MDM constructs were used in 123 cases, and LFHs were used in 176 cases. Mean age was 66 years (28 to 93), mean BMI was 31 kg/m2 (18 to 55), and 45% (n = 136) were female. Mean follow-up was seven years (2 to 12).
Results: The ten-year survival free of re-revision for dislocation was 99% (95% CI 95 to 100) in the MDM cohort and 91% (95% CI 84 to 96) in the LFH cohort, with a significantly increased risk of re-revision for dislocation in the LFH cohort (HR 7.1 (95% CI 1.3 to 40.8); p = 0.023). The ten-year survival free of any re-revision was 92% (95% CI 82 to 99%) in the MDM cohort and 84% (95% CI 74 to 90) in the LFH cohort with a significantly increased risk of any re-revision in the LFH cohort (HR 2.6 (95% CI 1.1 to 5.9); p = 0.024). The ten-year survival free of any dislocation was 95% (95% CI 85 to 99) in the MDM cohort and 87% (95% CI 78 to 92) in the LFH cohort with a significantly increased risk of any dislocation in the LFH cohort (HR 2.7 (95% CI 1.1 to 6.3); p = 0.028). There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.
Conclusion: In this head-to-head comparison, revision THAs with a MDM construct safely and effectively lowered the risk of re-revision for dislocation, any re-revision, and any dislocation compared to LFH at mid-term follow-up. There were no re-revisions or reoperations for metallosis or corrosion in the MDM cohort.
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