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Reduced Revision Risk for Dual-Mobility Cup in Total Hip Replacement Due to Hip Fracture : A Matched-Pair Analysis of 9,040 Cases from the Nordic Arthroplasty Register Association (NARA)

Jobory, Ammar LU ; Kärrholm, Johan; Overgaard, Søren; Becic Pedersen, Alma; Hallan, Geir; Gjertsen, Jan Erik; Mäkelä, Keijo and Rogmark, Cecilia LU (2019) In The Journal of bone and joint surgery. American volume 101(14). p.1278-1285
Abstract

BACKGROUND: The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation. METHODS: Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match... (More)

BACKGROUND: The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation. METHODS: Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match 4,520 hip fractures treated with a DMC to 4,520 hip fractures treated with conventional THA (control group). Competing risk regression analyses with revision or death as the end point were used. Revision was defined as a secondary surgical procedure in which any component of the implant was removed or exchanged. In addition, revision of the cup was analyzed. RESULTS: The DMCs had a lower risk of revision compared with conventional THA, with an adjusted hazard ratio (AHR) of 0.75 (95% confidence interval [CI] = 0.62 to 0.92). This was consistent after adjusting for surgical approach. DMCs had a lower risk of revision due to dislocation (AHR = 0.45 [95% CI = 0.30 to 0.68]) but we found no difference regarding revision for deep infection. Revision of the acetabular component, both in general and due to dislocation, was more frequent with the use of conventional cups. The risk of death was higher in the DMC group (AHR = 1.49 [95% CI = 1.40 to 1.59]). CONCLUSIONS: The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. The total number of DMCs analyzed (4,520) likely exceeds any cohort of DMC-treated fractures published to date. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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organization
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type
Contribution to journal
publication status
published
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in
The Journal of bone and joint surgery. American volume
volume
101
issue
14
pages
8 pages
publisher
Journal Bone Joint Surgery Inc
external identifiers
  • scopus:85070056873
ISSN
1535-1386
DOI
10.2106/JBJS.18.00614
language
English
LU publication?
yes
id
31b84f15-b3eb-4118-8398-8d447ebd5335
date added to LUP
2019-08-29 15:04:33
date last changed
2019-09-04 04:49:34
@article{31b84f15-b3eb-4118-8398-8d447ebd5335,
  abstract     = {<p>BACKGROUND: The dual-mobility acetabular cup (DMC) has an additional bearing consisting of a mobile polyethylene component between the prosthetic head and the outer metal shell. This design has gained popularity in revision total hip arthroplasty (THA) and in primary treatment of femoral neck fractures with the anticipation of a reduced risk of THA instability. Our primary aim was to evaluate the overall revision risk of these cups on the basis of data from the Nordic Arthroplasty Register Association (NARA) database, and our secondary aim was to study specific revision causes including dislocation. METHODS: Propensity score matching for age, sex, fixation of the cup and stem, and the year of surgery (2001 to 2014) was used to match 4,520 hip fractures treated with a DMC to 4,520 hip fractures treated with conventional THA (control group). Competing risk regression analyses with revision or death as the end point were used. Revision was defined as a secondary surgical procedure in which any component of the implant was removed or exchanged. In addition, revision of the cup was analyzed. RESULTS: The DMCs had a lower risk of revision compared with conventional THA, with an adjusted hazard ratio (AHR) of 0.75 (95% confidence interval [CI] = 0.62 to 0.92). This was consistent after adjusting for surgical approach. DMCs had a lower risk of revision due to dislocation (AHR = 0.45 [95% CI = 0.30 to 0.68]) but we found no difference regarding revision for deep infection. Revision of the acetabular component, both in general and due to dislocation, was more frequent with the use of conventional cups. The risk of death was higher in the DMC group (AHR = 1.49 [95% CI = 1.40 to 1.59]). CONCLUSIONS: The use of a DMC as primary treatment for hip fracture was associated with a lower risk of revision in general and due to dislocation in particular. The total number of DMCs analyzed (4,520) likely exceeds any cohort of DMC-treated fractures published to date. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>},
  author       = {Jobory, Ammar and Kärrholm, Johan and Overgaard, Søren and Becic Pedersen, Alma and Hallan, Geir and Gjertsen, Jan Erik and Mäkelä, Keijo and Rogmark, Cecilia},
  issn         = {1535-1386},
  language     = {eng},
  month        = {07},
  number       = {14},
  pages        = {1278--1285},
  publisher    = {Journal Bone Joint Surgery Inc},
  series       = {The Journal of bone and joint surgery. American volume},
  title        = {Reduced Revision Risk for Dual-Mobility Cup in Total Hip Replacement Due to Hip Fracture : A Matched-Pair Analysis of 9,040 Cases from the Nordic Arthroplasty Register Association (NARA)},
  url          = {http://dx.doi.org/10.2106/JBJS.18.00614},
  volume       = {101},
  year         = {2019},
}