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Intraprosthetic Dislocation of a Contemporary Dual-Mobility Design Used During Conversion THA

机译:转化期间THA使用的当代双活动设计的骨内错位

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Although dual-mobility sockets have been in clinical use for decades in other parts of the world, they recently gained popularity in the United States as an option for primary and revision total hip arthroplasty (THA). Improvements in dual-mobility socket technology include articulation with a metal insert impacted into a metal shell and a femoral head made of highly cross-linked polyethylene. The results and complications associated with the use of dual-mobility sockets employing these technologic advancements are not known. Specifically, intraprosthetic dislocation is a well-known complication of these implants and has been reported extensively in the literature. To the authors' knowledge, its occurrence in a modern dual-mobility socket has not been reported. The authors report a case of early intraprosthetic dislocation of a contemporary dual-mobility design used to convert a patient to THA after failed fixation of intertrochanteric hip fracture. At retrieval, there was evidence that the outer bearing may have ceased moving, causing localized focal impingement of the implant neck on the retentive ring. The authors theorized that external hip impingement (pelvic against trochanter) and previous surgery that led to the formation of scar tissue could have caused the outer bearing surface to cease its motion. This ultimately led to impingement of the femoral component neck on the retentive ring, which led to the intraprosthetic dislocation. Dual-mobility cups provide an attractive option to decrease wear and improve stability. Further research is needed to establish the ideal construct design and materials.
机译:尽管双活动插座在世界其他地区已经有数十年的临床使用,但它们最近在美国已普及,成为主要和翻修全髋关节置换术(THA)的一种选择。双活动承窝技术的改进包括铰接,其中金属插入件撞击金属外壳,而股骨头由高度交联的聚乙烯制成。与利用这些技术进步的双移动插座相关的结果和复杂性是未知的。具体而言,假体内脱位是这些植入物的众所周知的并发症,并且在文献中已有大量报道。据作者所知,尚未报道其在现代双移动插座中的发生。作者报告了一例当代双活动设计早期假体内脱位的案例,该设计用于在股骨转子间髋部骨折固定失败后将患者转换为THA。取回时,有证据表明外轴承可能已经停止移动,从而导致植入物颈部在固位环上发生局部聚焦撞击。作者认为,外部髋关节撞击(骨盆对转子)和先前导致疤痕组织形成的手术可能导致外轴承表面停止运动。这最终导致股骨颈撞击在固定环上,从而导致假体内脱位。双移动杯提供了减少磨损并提高稳定性的有吸引力的选择。需要进一步研究以建立理想的构造设计和材料。

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