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Sökning: WFRF:(Costa Cecilia) > (2020-2024) > Do Dual-mobility Cu...

Do Dual-mobility Cups Reduce Revision Risk in Femoral Neck Fractures Compared With Conventional THA Designs? An International Meta-analysis of Arthroplasty Registries

Farey, J. E. (författare)
Royal Prince Alfred Hospital
Masters, J. (författare)
University of Oxford
Cuthbert, A. R. (författare)
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Iversen, P. (författare)
van Steenbergen, L. N. (författare)
Prentice, H. A. (författare)
Kaiser Permanente
Adie, S. (författare)
University of New South Wales
Sayers, A. (författare)
University of Bristol
Whitehouse, M. R. (författare)
University Hospitals Bristol NHS Foundation Trust,University of Bristol
Paxton, E. W. (författare)
Kaiser Permanente
Costa, M. L. (författare)
University of Oxford
Overgaard, S. (författare)
University of Copenhagen,Bispebjerg Hospital
Rogmark, Cecilia (författare)
Lund University,Lunds universitet,Ortopedi - klinisk och molekylär osteoporosforskning,Forskargrupper vid Lunds universitet,Orthopedics - Clinical and Molecular Osteoporosis Research,Lund University Research Groups,Skåne University Hospital,Swedish Hip Arthroplasty Register
Rolfson, Ola, 1973 (författare)
Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för ortopedi,Institute of Clinical Sciences, Department of Orthopaedics,Sahlgrenska Academy,Swedish Hip Arthroplasty Register
Harris, I. A. (författare)
Royal Prince Alfred Hospital,University of New South Wales
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 (creator_code:org_t)
2022
2022
Engelska.
Ingår i: Clinical orthopaedics and related research. - 1528-1132 .- 0009-921X. ; 480:10, s. 1912-1925
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • BACKGROUND: Dual-mobility cups in THA were designed to reduce prosthesis instability and the subsequent risk of revision surgery in high-risk patients, such as those with hip fractures. However, there are limited data from clinical studies reporting a revision benefit of dual-mobility over conventional THA. Collaboration between anthroplasty registries provides an opportunity to describe international practice variation and compare between-country, all-cause revision rates for dual-mobility and conventional THA. QUESTIONS/PURPOSES: We summarized observational data from multiple arthroplasty registries for patients receiving either a dual-mobility or conventional THA to ask: (1) Is dual-mobility use associated with a difference in risk of all-cause revision surgery compared with conventional THA? (2) Are there specific patient characteristics associated with dual-mobility use in the hip fracture population? (3) Has the use of dual-mobility constructs changed over time in patients receiving a THA for hip fracture? METHODS: Six member registries of the International Society of Arthroplasty Registries (from Australia, Denmark, Sweden, the Netherlands, the United Kingdom, and the United States) provided custom aggregate data reports stratified by acetabular cup type (dual-mobility or conventional THA) in primary THA for hip fracture between January 1, 2002, and December 31, 2019; surgical approach; and patient demographic data (sex, mean age, American Society of Anesthesiologists class, and BMI). The cumulative percent revision and mortality were calculated for each registry. To determine a global hazard ratio of all-cause revision for dual-mobility compared with conventional THA designs, we used a pseudoindividual patient data approach to pool Kaplan-Meier prosthesis revision data from each registry and perform a meta-analysis. The pseudoindividual patient data approach is a validated technique for meta-analysis of aggregate time-to-event survival data, such as revision surgery, from multiple sources. Data were available for 15,024 dual-mobility THAs and 97,200 conventional THAs performed for hip fractures during the study period. RESULTS: After pooling of complete Kaplan-Meier survival data from all six registries, the cumulative percent revision for conventional THA was 4.3% (95% confidence interval [CI] 4.2% to 4.5%) and 4.7% (95% CI 4.3% to 5.3%) for dual-mobility THA at 5 years. We did not demonstrate a lower risk of all-cause revision for patients receiving dual-mobility over conventional THA designs for hip fracture in the meta-analysis once between-registry differences were adjusted for (HR 0.96 [95% CI 0.86 to 1.06]). A lower proportion of dual-mobility procedures were revised for dislocation than conventional THAs (0.9% versus 1.4%) but a higher proportion were revised for infection (1.2% versus 0.8%). In most registries, a greater proportion of dual-mobility THA patients were older, had more comorbidities, and underwent a posterior approach compared with conventional THA (p < 0.001). The proportion of dual-mobility THA used to treat hip fractures increased in each registry over time and constituted 21% (2438 of 11,874) of all THA procedures in 2019. CONCLUSION: The proportion of dual-mobility THAs in patients with hip fractures increased over time, but there was large variation in use across countries represented here. Dual-mobility cups were not associated with a reduction in the overall risk of revision surgery in patients with hip fractures. A randomized controlled trial powered to detect the incidence of dislocation and subsequent revision surgery is required to clarify the efficacy of dual-mobility cups to treat hip fractures. LEVEL OF EVIDENCE: Level III, therapeutic study. Copyright © 2022 by the Association of Bone and Joint Surgeons.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

Nyckelord

adverse device effect
adverse event
femoral neck fracture
hip fracture
hip prosthesis
hip replacement
human
meta analysis
procedures
prosthesis complication
prosthesis design
randomized controlled trial (topic)
register
reoperation
risk factor
Arthroplasty
Replacement
Hip
Femoral Neck Fractures
Hip Fractures
Humans
Prosthesis Failure
Randomized Controlled Trials as Topic
Registries
Risk Factors

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