Dual-Mobility Constructs in Primary Total Hip Arthroplasty in High-Risk Patients With Spinal Fusions: Our Institutional Experience

Arthroplasty Today

Marie Syku, BS¹  Brian P. Chalmers, MD²  David J. Mayman, MD³  Seth A. Jerabek, MD³  Thomas P. Sculco, MD³  Geoffrey H. Westrich, MD³ 

[1] Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA;Corresponding author. 535 East 70th Street, New York, NY 10021, USA. Tel.: [phone].;Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA;

关键词: Total hip arthroplasty;    Lumbar arthrodesis;    Lumbar fusion;    Dislocation;    Dual mobility;    Complications;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Prior spinal fusion significantly increases the risk of dislocation in patients after total hip arthroplasty (THA). Owing to these high risks, surgeons may use dual-mobility (DM) constructs in these patients to optimize hip stability. However, there is a paucity of data on the outcomes of DM constructs in patients who underwent prior spinal fusions. Methods: We retrospectively identified 80 patients (86 THAs) who underwent a spinal arthrodesis and a subsequent posterior approach THA with a DM construct. The median number of levels fused was 4, with 59 (74%) patients having 2 or more levels fused; in addition, 50 (63%) patients were fused to the sacrum. Ninety percent and 55% of THAs were within the Lewinnek safe zone for inclination and anteversion, respectively. Patients were evaluated for any episode of hip instability, complications, and patient reported outcome measures. Results: At 3-year mean follow-up, no patients sustained a postoperative dislocation or intraprosthetic dislocation (0%). Overall, there were 6 (7.5%) complications during the study period leading to reoperation in 3 (4%) patients, none related to the acetabular component or instability. Hip Injury and Osteoarthritis Outcome Score, Joint Replacement scores significantly improved from a mean of 50 preoperatively to 87 postoperatively (P < .001), and the Veterans Rand 12 Item Health Survey physical score improved from a mean of 31 preoperatively to 44 postoperatively (P < .001). Conclusion: In a high-risk series of patients who underwent prior spinal fusion, posterolateral primary THA with a DM construct demonstrated no dislocations at mean 3-year follow-up. Although these early data are clearly encouraging, more patients with longer term follow-up are needed.

【 授权许可】

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