The use of dual mobility endoprostheses in patients with unsatisfactory outcomes of trochanteric fractures fixed with a sliding hip screw system (SHS)

Abstract

The OBJECTIVE was to evaluate the results of using dual mobility endoprostheses in patients with unsatisfactory outcomes of osteosynthesis of trochanteric fractures using a sliding hip screw system.METHODS AND MATERIALS. A single-center, retrospective, randomized study was conducted in 60 patients with unfavorable consequences of osteosynthesis of the proximal femur with the DHS system. All patients were divided into 2 groups. The first group consisted of 31 (51.6 %) patients who were implanted with standard cemented acetabular components. The second group included 29 (48.4 %) patients who were implanted with cement-retained dual mobility endoprostheses. We assessed the functional state using the Oxford Hip Score, the level of pain on the visual analogue scale, the degree of disability, the duration of the operation, blood loss, the nature and structure of complications, the frequency of revision interventions.RESULTS. The functional state on the Oxford score did not have significant differences between the groups, amounting to 41.7 points after 12 months. The level of pain syndrome did not differ significantly between the groups, amounting to 0.4 points after 12 months. The average volume of intraoperative blood loss was 629.2 ml, which is significantly higher in comparison with standard primary arthroplasty. In the 1st group, there were significantly higher rates of dislocations (6 patients or 19.35 %). The relative risk of endoprosthesis dislocation was 5.8. A total of 5 (8.34 %) infectious complications were noted in both study groups, which is significantly higher in comparison with the results of primary arthroplasty among patients without previous fractures. According to the degree of disability, there was no significant difference between the groups after 12 months. The average score was 2.06 points.CONCLUSION. In conversion hip arthroplasty using standard acetabular components, a greater number of orthopedic complications (25.81 %) are noted. The use of dual mobility slightly increases the duration of arthroplasty without causing an increase in blood loss or the number of infectious complications. The frequency of dislocations in conversion arthroplasty using standard implants is 19.3 %.