Outcomes and survival of a modern dual mobility cup and uncemented collared stem in displaced femoral neck fractures at a minimum 5-year follow-up - 03/02/22
, Mathieu Fauvernier c, d, Marcelle Mercier a, Philippe Chaudier a, Mathieu Severyns e, Michel-Henri Fessy a, b
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Abstract |
Introduction |
The choice of implant type for total hip replacement in the treatment of femoral neck fractures remains debated. Some authors advocate for the systematic use of cemented stems, while others do not use dual mobility first-line. We therefore conducted a retrospective study using a dual mobility cup (DMC) and an uncemented collared stem (UCS) in order to: (1) confirm the low dislocation rate in this indication, (2) assess other surgical complications, in particular periprosthetic fractures, (3) ensure that these benefits are maintained over time, at a minimum follow-up of 5 years and, (4) assess the rate of revision of the implants.
Hypothesis |
Our hypothesis was that the dual mobility dislocation rate for the treatment of femoral neck fractures was lower than for bipolar hemiarthroplasties or single mobility hip prostheses.
Patients and methods |
A retrospective study of 244 femoral neck fractures (242 patients) treated with DMC and UCS was conducted, between 2013 and 2014. The mean age was 83±10 years (60–104). The occurrence of dislocation, periprosthetic fracture, infection of the surgical site, loosening, reoperation and revision were investigated. The HOOS Joint Replacement (JR) score was collected. The cumulative incidence with mortality was used as a competing risk.
Results |
The mean follow-up was 6 years±0.5 (5–7). At the last follow-up, 108 patients (50%) had died. Twenty-three patients (9.5%) were lost to follow-up. One case of symptomatic aseptic loosening of DMC was observed. The cumulative incidence of dislocations and periprosthetic fractures at 5 years were 2% (95% CI: 0.9–5.4) and 3% (95% CI: 1.2–6), respectively. The 5-year cumulative incidence of surgical site infections was 3.5% (95% CI: 1.8–7). The cumulative incidence of reoperations at 5 years was 7% (95% CI: 4.5–11). The causes of reoperation were periprosthetic fracture (n=6), infection (n=8), postoperative hematoma (n=2) and cup malposition (n=2). The cumulative incidence of a revision at 5 years was 2.7% (95% CI: 1.2–6). The cumulative incidence of a surgical complication from any cause at 5 years was 9% (95% CI: 6.7–14.8). The mean HOOS JR score was 79±5 (52–92).
Discussion |
The cumulative incidence of dislocation at 5 years is low and other surgical complications (including periprosthetic fractures) do not increase during this period for DMC associated with UCS, in femoral neck fractures. The use of this type of implant is reliable in the treatment of femoral neck fractures.
Level of evidence |
IV; retrospective study without control group.
Le texte complet de cet article est disponible en PDF.Keywords : Dual mobility, Uncemented stem, Displaced femoral neck fracture, Total hip arthroplasty, Hip Dislocation, Periprosthetic fracture
Plan
Vol 108 - N° 1
Article 103164- février 2022 Retour au numéro
Article précédent
- Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: A systematic review and network meta-analysis of randomized controlled trials
- Natthapong Hongku, Patarawan Woratanarat, Lertkong Nitiwarangkul, Sasivimol Rattanasiri, Ammarin Thakkinstian
- Comparative study of total hip arthroplasties with dual mobility cups versus hemiarthroplasties in management of femoral neck fractures: Survival and dislocation rate at 5 years of follow-up?
- Juliette Bertault-Le Gourrierec, Etienne Cavaignac, Emilie Berard, Federico Moretti, Vincent Marot, Philippe Chiron, Nicolas Reina
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