Results of this private regional register confirm the high efficiency of DMC to decrease dislocation rate (0.23%). Few outcomes of DMC in primary total hip arthroplasty (THA) are published in national registries. The Swedish Hip Arthroplasty Register has reported on 287 primary DMC hips of 78,098 THAs. No dislocations were reported. We conclude that DMC decreases dislocation rate, and the national registry of Lithuania also reports a significant decrease in the rate of revision for dislocation in the DMC group. These data-available online-allow us to monitor DMC in real time, although they lack short-term follow-up.
These results are better than those of first generation (BOUSQUET) DMC (77 % of survival rate at 20 years of FU). These results are in the same agreement than those of the literature: 99 % of survival rate at 14.2 years of FU for KERBOULL with a low friction arthroplasty and 96.5 % at ten years of FU for ceramic/ceramic bearing (R CHANA). The DMC for young patient is a relevant surgical option with no dislocation and excellent clinical results and survival rate at more than ten years of FU.
Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use routinely for hemiarthroplasty or THA in the cases of unstable ECTF. It reduces complications usually linked to this procedure. Blood loss, operating time, and pain are limited, allowing fast recovery in order to decrease morbidity and mortality.
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