BACKGROUND The increased availability of dual-mobility acetabular constructs (DMCs) provides surgeons with a newer option to increase the effective femoral head size in revision total hip arthroplasty (rTHA). We sought to evaluate risks of re-revision and prosthetic dislocation following rTHA involving a DMC compared with other articulations. METHODS A cohort study was conducted using data from a U.S. integrated health-care system's Total Joint Replacement Registry. Adult patients who underwent primary THA and went on to undergo an aseptic rTHA in 2002 to 2022 were identified. Patients who received a DMC, a constrained liner, or a metal or ceramic unipolar femoral head on highly cross-linked polyethylene (XLPE) at the time of rTHA were the treatment groups. Subsequent aseptic re-revision and dislocation were the outcomes of interest. Multivariable Cox proportional-hazards regression was used to evaluate the risks of the outcomes, with adjustment for patient, operative, and surgeon confounders. RESULTS The analyzed rTHAs comprised 375 with a DMC, 268 with a constrained liner, 995 with a <36-mm head on XLPE, and 2,087 with a ≥36-mm head on XLPE. DMC utilization increased from 1.0% of rTHAs in 2011 to 21.6% in 2022. In adjusted analyses, a higher re-revision risk was observed for the constrained liner (hazard ratio [HR] = 2.43, 95% confidence interval [CI] = 1.29 to 4.59), <36 mm on XLPE (HR = 2.05, 95% CI = 1.13 to 3.75), and ≥36 mm on XLPE (HR = 2.03, 95% CI = 1.19 to 3.48) groups compared with the DMC group. A higher dislocation risk was observed in both XLPE groups (<36 mm: HR = 2.04, 95% CI = 1.33 to 3.14; ≥36 mm: HR = 2.46, 95% CI = 1.69 to 3.57) compared with the DMC group; a nonsignificant trend toward a higher dislocation rate in the group with a constrained liner than in the DMC group was also observed. CONCLUSIONS In a large U.S.-based cohort, rTHAs using DMCs had the lowest re-revision risk and dislocation risk. Both outcomes were significantly lower than those using a unipolar femoral head on XLPE, re-revision risk was significantly lower than using a constrained liner, and dislocation risk trended toward a lower risk than using a constrained liner. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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翻修全髋关节置换术中的双活动关节：与高度交联聚乙烯和受限关节上的金属或陶瓷的比较。


背景 双活动髋臼结构 （DMC） 的可用性增加为外科医生提供了一种新的选择，可以在翻修全髋关节置换术 （rTHA） 中增加有效的股骨头尺寸。我们试图评估与其他关节相比，涉及 DMC 的 rTHA 后翻修和修复脱位的风险。方法 使用来自美国综合医疗保健系统全关节置换登记处的数据进行了一项队列研究。确定了 2002 年至 2022 年接受原发性 THA 并继续接受无菌 rTHA 的成年患者。在 rTHA 时接受 DMC 、受限衬垫或在高度交联聚乙烯 （XLPE） 上接受金属或陶瓷单极股骨头的患者是治疗组。随后的无菌再翻修和脱位是感兴趣的结局。多变量 Cox 比例风险回归用于评估结局风险，并针对患者、手术和外科医生的混杂因素进行调整。结果分析的 rTHA 包括 375 个具有 DMC，268 个具有约束衬里，995 个具有 <36 mm 头部的 XLPE 和 2,087 个具有 ≥36 mm 头部的 XLPE。DMC 利用率从 2011 年的 rTHA 的 1.0% 增加到 2022 年的 21.6%。在调整后的分析中，观察到约束衬垫组 （风险比 [HR] = 2.43,95% 置信区间 [CI] = 1.29 至 4.59）、XLPE 上的 <36 mm （HR = 2.05,95% CI = 1.13 至 3.75） 和 XLPE 上的 ≥36 mm （HR = 2.03,95% CI = 1.19 至 3.48） 组与 DMC 组相比。在两个 XLPE 组中观察到较高的脱位风险 （<36 mm： HR = 2.04， 95% CI = 1.33 至 3.14;≥36 mm： HR = 2.46,95% CI = 1.69 至 3。57） 与 DMC 组相比;还观察到衬垫受限组脱位率高于 DMC 组的不显著趋势。结论 在美国的大型队列中，使用 DMCs 的 rTHA 的再翻修风险和脱位风险最低。两种结局均显著低于在 XLPE 上使用单极股骨头的结果，再翻修风险显著低于使用受限衬垫，脱位风险趋于低于使用受限衬垫的风险。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。