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Войти в исследования The Journal of arthroplasty · 2026
The John Charnley Award: A Randomized Controlled Trial of Dual Mobility and Single Bearings for Patients at High Risk of Dislocation Following Primary Total Hip Arthroplasty.
СтатьяРандомизированное исследованиеМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Potluri Ajay S, Yadav Aditya S, Weintraub Matthew T, DeBenedetti Anne, Della Valle Craig J, Schwarzkopf Ran, Courtney Paul M, Heckmann Nathanael, Nam Denis
Аннотация
BACKGROUND: This multicenter randomized controlled trial sought to determine if dual-mobility (DM) bearings reduce dislocations in patients at high-risk for instability undergoing primary total hip arthroplasty compared to single bearing (SB) femoral heads.
METHODS: A total of 555 patients undergoing primary posterior approach total hip arthroplasty were randomized to DM (n = 271; 42 mm mean effective head, range 36 to 55) or SB heads (n = 284; 28 mm [n = 2], 32 mm [n = 42], 36 mm [n = 168], 40 mm [n = 61], 44 mm [n = 11]). High-risk criteria included the following: prior lumbo-sacral fusion (n = 170) or other inclusions (age ≥ 75 years , preoperative combined flexion-adduction-internal rotation ≥ 115°, substance abuse, inflammatory arthritis, neuromuscular disorder, removal of hardware, cognitive impairment, acute displaced femoral neck fracture, and kyphosis/scoliosis; n = 385). There were 28 patients (5.0%) lost to follow-up before 90 days, leaving 527 patients followed for a median of 23 months (range, 3.0 to 87.2).
RESULTS: There were two dislocations in the DM group and six in the SB group (0.7 versus 2.1%, P = 0.29). There was no difference in 2-year dislocation-free survivorship between cohorts (DM: 99.0 versus SB: 97.6%; P = 0.63). There were 16 hips revised (DM: 2.2 versus SB: 3.5%; P = 0.45), with no difference in 2-year all-cause revision-free survivorship (DM: 97.5 versus SB: 96.4%; P = 0.53). Infection was the most common revision indication (two DM [0.7%] versus five SB [1.8%]). There were no differences in patient-reported outcome measures at any time point (P > 0.05).
CONCLUSION: In this multicenter randomized controlled trial, DM bearings were associated with a threefold reduction in dislocation risk, but given the lower than anticipated overall dislocation rate, this difference did not reach statistical significance. Further follow-up is required to capture late dislocations or instability.
METHODS: A total of 555 patients undergoing primary posterior approach total hip arthroplasty were randomized to DM (n = 271; 42 mm mean effective head, range 36 to 55) or SB heads (n = 284; 28 mm [n = 2], 32 mm [n = 42], 36 mm [n = 168], 40 mm [n = 61], 44 mm [n = 11]). High-risk criteria included the following: prior lumbo-sacral fusion (n = 170) or other inclusions (age ≥ 75 years , preoperative combined flexion-adduction-internal rotation ≥ 115°, substance abuse, inflammatory arthritis, neuromuscular disorder, removal of hardware, cognitive impairment, acute displaced femoral neck fracture, and kyphosis/scoliosis; n = 385). There were 28 patients (5.0%) lost to follow-up before 90 days, leaving 527 patients followed for a median of 23 months (range, 3.0 to 87.2).
RESULTS: There were two dislocations in the DM group and six in the SB group (0.7 versus 2.1%, P = 0.29). There was no difference in 2-year dislocation-free survivorship between cohorts (DM: 99.0 versus SB: 97.6%; P = 0.63). There were 16 hips revised (DM: 2.2 versus SB: 3.5%; P = 0.45), with no difference in 2-year all-cause revision-free survivorship (DM: 97.5 versus SB: 96.4%; P = 0.53). Infection was the most common revision indication (two DM [0.7%] versus five SB [1.8%]). There were no differences in patient-reported outcome measures at any time point (P > 0.05).
CONCLUSION: In this multicenter randomized controlled trial, DM bearings were associated with a threefold reduction in dislocation risk, but given the lower than anticipated overall dislocation rate, this difference did not reach statistical significance. Further follow-up is required to capture late dislocations or instability.