Malseating of modular dual mobility liners.
Malseating of modular dual mobility liners.
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DOI：
10.1302/2633-1462.210.bjo-2021-0124.r1
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发表时间：
2021-10
期刊：
影响因子：
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通讯作者：
Nam D
中科院分区：
文献类型：
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作者：
Guntin J;Plummer D;Della Valle C;DeBenedetti A;Nam D
之前的研究已经确定，组配式双动内衬可能发生错位，之前报告的发生率在5.8%-16.4%之间。本研究的目的是确定我们机构双移动种植体的错位发生率，评估内衬错位的风险因素，并调查内衬错位是否对术后临床结局有任何影响。我们回顾性分析了239例初次和翻修全髋关节置换术（使用组配式双移动内衬）的X线片。两名独立的评审员对每位患者的X线片进行了两次评估，以确定是否存在错位的证据，第三名观察员担任决胜局。进行单变量分析以确定错位的风险因素，使用Youden指数确定临界点。使用Cohen kappa检验测量观察者间和观察者内的可靠性。总共有12件内衬（5.0%），包括8件斯特赖克（6.8%）和4件Zimmer Biomet（3.3%），存在错位的放射学证据。观察者间可靠性为0.453（95%置信区间（CI）为0.26至0.64），表明评分者间一致性较弱，一致性较强，大于0.8。在单变量分析中，我们发现50 mm或更小的部件尺寸与内衬错位相关（p = 0.031）。内衬错位的患者似乎没有相关的临床后果，并且在术后平均14个月（1.4 - 99.2）时没有患者需要翻修手术。内衬错位的发生率为5.0%，与其他报告相似。50 mm或更小的部件尺寸被确定为错位的风险因素。外科医生应意识到可能发生错位，应考虑改变植入物设计或手术工具以降低错位风险。虽然需要进一步随访，但错位是否与任何临床后果相关仍有待观察。引用这篇文章：Bone Jt Open 2021;2（10）：858-864。
Prior studies have identified that malseating of a modular dual mobility liner can occur, with previous reported incidences between 5.8% and 16.4%. The aim of this study was to determine the incidence of malseating in dual mobility implants at our institution, assess for risk factors for liner malseating, and investigate whether liner malseating has any impact on clinical outcomes after surgery. We retrospectively reviewed the radiographs of 239 primary and revision total hip arthroplasties with a modular dual mobility liner. Two independent reviewers assessed radiographs for each patient twice for evidence of malseating, with a third observer acting as a tiebreaker. Univariate analysis was conducted to determine risk factors for malseating with Youden’s index used to identify cut-off points. Cohen’s kappa test was used to measure interobserver and intraobserver reliability. In all, 12 liners (5.0%), including eight Stryker (6.8%) and four Zimmer Biomet (3.3%), had radiological evidence of malseating. Interobserver reliability was found to be 0.453 (95% confidence interval (CI) 0.26 to 0.64), suggesting weak inter-rater agreement, with strong agreement being greater than 0.8. We found component size of 50 mm or less to be associated with liner malseating on univariate analysis (p = 0.031). Patients with malseated liners appeared to have no associated clinical consequences, and none required revision surgery at a mean of 14 months (1.4 to 99.2) postoperatively. The incidence of liner malseating was 5.0%, which is similar to other reports. Component size of 50 mm or smaller was identified as a risk factor for malseating. Surgeons should be aware that malseating can occur and implant design changes or changes in instrumentation should be considered to lower the risk of malseating. Although further follow-up is needed, it remains to be seen if malseating is associated with any clinical consequences. Cite this article: Bone Jt Open 2021;2(10):858–864.