Preliminary Outcomes with Dual Mobility Cups in Patients Older Than 65 With Hip Fractures. A Retrospective Analysis of 102 Patients
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Published:
Oct 17, 2023
Keywords:
Elderly patients, hip fracture, double mobility prosthesis, dislocation, reoperation
Main Article Content
Abstract
Objective: This retrospective study aimed to assess the functional outcomes and dislocation rate in the treatment with dual mobility prostheses in patients older than 65 with hip fractures.
Materials and Methods: We analyzed all patients treated between 2017 and 2021 for hip fractures in our service. We included patients older than 65 years, treated with dual mobility cups, and a minimum follow-up of 24 months. We analyzed demographic data, comorbidities, functional outcomes (Parker score and Harris Hip Score, HHS), complications (infection, dislocation, loosening), reoperations, and revisions.
Results: We included 102 hip fractures (75 medial and 27 intertrochanteric) in 102 patients. Seventy-four (72.5%) were women, the mean age was 80.59 ± 6.92 years, the mean Charlson index was 4.71 (range 3-10), and ASA was 2.47 (1-4). 93.1% started walking on the second postoperative day. 94.1% presented excellent or very good outcomes according to the HHS, the postoperative Parker index did not show significant differences in comparison to the preoperative one (p < 0.05). The average follow-up was 30 months (range 24-60). There were 8 (7.84%) complications: 2 (1.9%) deep vein thrombosis, 4 (3.9%) pulmonary thromboembolism, 3 infections (2.9%), and 1 (0.9%) dislocation. The reoperation rate was 2.9%.
Conclusions: We obtained acceptable functional outcomes using dual mobility cups with a relatively low dislocation rate (0.9%). This suggests that these implants are an option to consider in treating these lesions.
Materials and Methods: We analyzed all patients treated between 2017 and 2021 for hip fractures in our service. We included patients older than 65 years, treated with dual mobility cups, and a minimum follow-up of 24 months. We analyzed demographic data, comorbidities, functional outcomes (Parker score and Harris Hip Score, HHS), complications (infection, dislocation, loosening), reoperations, and revisions.
Results: We included 102 hip fractures (75 medial and 27 intertrochanteric) in 102 patients. Seventy-four (72.5%) were women, the mean age was 80.59 ± 6.92 years, the mean Charlson index was 4.71 (range 3-10), and ASA was 2.47 (1-4). 93.1% started walking on the second postoperative day. 94.1% presented excellent or very good outcomes according to the HHS, the postoperative Parker index did not show significant differences in comparison to the preoperative one (p < 0.05). The average follow-up was 30 months (range 24-60). There were 8 (7.84%) complications: 2 (1.9%) deep vein thrombosis, 4 (3.9%) pulmonary thromboembolism, 3 infections (2.9%), and 1 (0.9%) dislocation. The reoperation rate was 2.9%.
Conclusions: We obtained acceptable functional outcomes using dual mobility cups with a relatively low dislocation rate (0.9%). This suggests that these implants are an option to consider in treating these lesions.
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Garabano, G., Alonso, M. I., Pérez Alamino, L., Jaime, A., Cullari, M., & Pesciallo, C. Á. (2023). Preliminary Outcomes with Dual Mobility Cups in Patients Older Than 65 With Hip Fractures. A Retrospective Analysis of 102 Patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(5), 520-526. https://doi.org/10.15417/issn.1852-7434.2023.88.5.1757
Section
Clinical Research
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References
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Joint Surg Am 2005;87(8):1680-8. https://doi.org/10.2106/JBJS.D.02655
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displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop
Trauma Surg 2019;139(5):605-12. https://doi.org/10.1007/s00402-018-3093-8
9. De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J
Orthop 2014;5(3):180-7. https://doi.org/10.5312/wjo.v5.i3.180
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Traumatol 2009;74(1):102-10. Disponible en: http://www.scielo.org.ar/pdf/raaot/v74n1/v74n1a16.pdf
11. Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, et al. Survival of cementless dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 2008;94(8):e23-7.
https://doi.org/10.1016/j.rco.2007.10.013
12. Peirano F. Artroplastia total de cadera con articulación de doble movilidad. Estudio retrospectivo en pacientes con riesgo de luxación. Revista ACARO 2019:5(1):16-24. Disponible en: https://acarorevista.org.ar/images/revistas/05_01/05_01_04_Peirano/05_01_04_Peirano.pdf
13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in
longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
14. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993;75(5):797-8. https://doi.org/10.1302/0301-620X.75B5.8376443
15. DeLee J, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;
(121):20-32. PMID: 991504
16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-40. PMID: 5783851
17. Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial
comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 2007;89(2):160-5. https://doi.org/10.1302/0301-620X.89B2.18576
18. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of bipolar
hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011;93(5):445-50. https://doi.org/10.2106/JBJS.J.00474
19. Pfeufer D, Zeller A, Mehafey S, Böcker W, Kammerlander C, Neuerburg C. Weight‑bearing restrictions reduce
postoperative mobility in elderly hip fracture patients Arch Orthop Trauma Surg 2019;139(9):1253-9.
https://doi.org/10.1007/s00402-019-03193-9
20. Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand 2000;71(6):597-602. https://doi.org/10.1080/000164700317362235
21. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A metaanalysis of one hundred and six published reports. J Bone Joint Surg Am 1994;76(1):15-25.
https://doi.org/10.2106/00004623-199401000-00003
22. Darrith B, Courtney PM, Della Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a
systematic review of the literature. Bone Joint J 2018;100-B(1):11-9. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0462.R1
23. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH; French Society of Orthopaedic
Surgery and Traumatology (SoFCOT). Dual mobility cups hip arthroplasty as a treatment for displaced fracture of
the femoral neck in the elderly. A prospective, systematic, multicenter study with a specific focus on postoperative dislocation. Orthop Traumatol Surg Res 2012;98(3):296-300. https://doi.org/10.1016/j.otsr.2012.01.005
24. Guan J, Jinag FJ, Zhao H. [Correlation analysis of the influence of direct lateral approach and posterolateral
approach on reoperation and dislocation in patients with femoral neck fracture]. Zhongguo Gu Shang 2020;33(1):43-6. [En chino] https://doi.org/10.3969/j.issn.1003-0034.2020.01.008
25. Rashed RA, Sevenoaks H, Shabaan AM, Choudry QA, Hammad AS, Kasem MS, et al. Functional outcome and
health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in
middle-aged Egyptian patients. Injury 2018;49(3):667-72. https://doi.org/10.1016/j.injury.2018.01.006
College of Physicians (UK); 2011. PMID: 22420011
2. Parker MJ, Gurusamy KS, Azegami S. Arthroplasties (with and without bone cement) for proximal femoral
fractures in adults. Cochrane Database Syst Rev 2010;6(6):CD001706. https://doi.org/10.1002/14651858.CD001706.pub4
3. Yu L, Wang Y, Chen J. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures: metaanalysis of randomized trials. Clin Orthop Relat Res 2012;470(8):2235-43. https://doi.org/10.1007/s11999-012-2293-8
4. Gjertsen JE, Lie SA, Fevang JM, Havelin LI, Engesaeter LB, Vinje T, et al. Total hip replacement after femoral neck
fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 2007;78(4):491-7. https://doi.org/10.1080/1745367071001413
5. Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Comparison of internal fixation with total hip
replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone
Joint Surg Am 2005;87(8):1680-8. https://doi.org/10.2106/JBJS.D.02655
6. Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 1972;54(1):61-76. PMID: 5011747
7. McKee GK, Watson-Farrar J. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br
1966;48(2):245-59. PMID: 5937593
8. Tabori-Jensen S, Hansen TB, Stilling M. Low dislocation rate of Saturne®/Avantage® dual-mobility THA after
displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop
Trauma Surg 2019;139(5):605-12. https://doi.org/10.1007/s00402-018-3093-8
9. De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J
Orthop 2014;5(3):180-7. https://doi.org/10.5312/wjo.v5.i3.180
10. Valdez S, Bertrand B. Cotilos con doble movilidad: principios, ventajas y resultados. Rev Asoc Argent Ortop
Traumatol 2009;74(1):102-10. Disponible en: http://www.scielo.org.ar/pdf/raaot/v74n1/v74n1a16.pdf
11. Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, et al. Survival of cementless dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 2008;94(8):e23-7.
https://doi.org/10.1016/j.rco.2007.10.013
12. Peirano F. Artroplastia total de cadera con articulación de doble movilidad. Estudio retrospectivo en pacientes con riesgo de luxación. Revista ACARO 2019:5(1):16-24. Disponible en: https://acarorevista.org.ar/images/revistas/05_01/05_01_04_Peirano/05_01_04_Peirano.pdf
13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in
longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
14. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br 1993;75(5):797-8. https://doi.org/10.1302/0301-620X.75B5.8376443
15. DeLee J, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 1976;
(121):20-32. PMID: 991504
16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fracture: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51(4):737-40. PMID: 5783851
17. Blomfeldt R, Törnkvist H, Eriksson K, Söderqvist A, Ponzer S, Tidermark J. A randomised controlled trial
comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients. J Bone Joint Surg Br 2007;89(2):160-5. https://doi.org/10.1302/0301-620X.89B2.18576
18. Hedbeck CJ, Enocson A, Lapidus G, Blomfeldt R, Törnkvist H, Ponzer S, et al. Comparison of bipolar
hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am 2011;93(5):445-50. https://doi.org/10.2106/JBJS.J.00474
19. Pfeufer D, Zeller A, Mehafey S, Böcker W, Kammerlander C, Neuerburg C. Weight‑bearing restrictions reduce
postoperative mobility in elderly hip fracture patients Arch Orthop Trauma Surg 2019;139(9):1253-9.
https://doi.org/10.1007/s00402-019-03193-9
20. Johansson T, Jacobsson SA, Ivarsson I, Knutsson A, Wahlström O. Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips. Acta Orthop Scand 2000;71(6):597-602. https://doi.org/10.1080/000164700317362235
21. Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A metaanalysis of one hundred and six published reports. J Bone Joint Surg Am 1994;76(1):15-25.
https://doi.org/10.2106/00004623-199401000-00003
22. Darrith B, Courtney PM, Della Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a
systematic review of the literature. Bone Joint J 2018;100-B(1):11-9. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0462.R1
23. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Molé D, Fessy MH; French Society of Orthopaedic
Surgery and Traumatology (SoFCOT). Dual mobility cups hip arthroplasty as a treatment for displaced fracture of
the femoral neck in the elderly. A prospective, systematic, multicenter study with a specific focus on postoperative dislocation. Orthop Traumatol Surg Res 2012;98(3):296-300. https://doi.org/10.1016/j.otsr.2012.01.005
24. Guan J, Jinag FJ, Zhao H. [Correlation analysis of the influence of direct lateral approach and posterolateral
approach on reoperation and dislocation in patients with femoral neck fracture]. Zhongguo Gu Shang 2020;33(1):43-6. [En chino] https://doi.org/10.3969/j.issn.1003-0034.2020.01.008
25. Rashed RA, Sevenoaks H, Shabaan AM, Choudry QA, Hammad AS, Kasem MS, et al. Functional outcome and
health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in
middle-aged Egyptian patients. Injury 2018;49(3):667-72. https://doi.org/10.1016/j.injury.2018.01.006