Outcomes of primary total hip arthroplasty using dual mobility cups across body mass index categories: a multi-centric cohort study
摘要
Performing a total hip arthroplasty (THA) in obese patients is known to be associated with an elevated rate of complications. The use of dual mobility cups (DMC) has already been proven for decreasing dislocation episodes in high-risk populations. This is an observational cohort study evaluating the functional and radiological outcomes of DMC across BMI categories namely healthy, overweight and obese populations.
MethodologyThis is a retrospective multi-centric study of 419 patients who underwent a primary THA with a DMC (THA-DMC) from 2006 to 2022. The patients were divided in three groups according to their BMI and were evaluated clinically with the modified Hip Harris Score (mHHS) and radiologically. Post-operative complications were recorded during the follow-up period.
ResultsThe mean age of the included patients was 70 ± 13.19 years (p = 0.006). The mean follow-up period was nine ± 6.2 years. At final follow-up, the mean modified HHS score was 85.56 ± 6.09 in the normal weight subgroup vs 92.39 ± 4.89 in the overweight subgroup and 89.24 ± 4.40 in the obese subgroup (p = 0.2). Three patients, one in the overweight and two in the obese subgroups, had a traumatic dislocation unrelated to the surgery. No cases of intraprosthetic dislocations were observed. Two patients in the obesity subgroup required additional surgeries for septic complication. The radiological assessment revealed no signs of migration or tilting of the components. Osteolysis was detected in 4 cases with non-progressive lines and no symptoms at last follow up. Heterotopic ossifications were observed in 15 asymptomatic patients. Three patients had a traumatic peri-prosthetic fracture.
DiscussionThe use of a contemporary dual mobility cup in obese patients seems to yield excellent functional and radiological outcomes with a complication rate comparable to that of a non-obese population. Comparative studies with conventional cups are needed to confirm or infirm our results.