Evaluation of the effectiveness of the use of the double mobility in oncological hip replacement

Abstract

Introduction. Currently, the achievements of oncological hip replacement play an important role in the treatment and rehabilitation of patients with a tumor lesion of the proximal femur. The study objective – to evaluate the effectiveness of the use of the acetabulum component with double mobility in oncological hip replacement. Materials and methods. Our prospective study included 108 patients operated in the Department of Bone Oncology of the R.R. Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russia for a tumor lesion of the proximal femur in the period from 2014 to 2019. There were 65 (60.2 %) women, 43 (39.8 %) men. The median age was 52.1 years. Primary malignant bone tumors were identified in 19 (17.6 %) cases; benign aggressive and tumor-like diseases in 18 (16.6 %) cases; metastatic lesion in 71 (65.8 %) cases. Patients operated with bipolar heads were included in Group 1B – 53 (49 %). The 2D Group included 55 (51 %) patients operated with the use of the acetabulum component with dual mobility. Classification and analysis of complications was carried out according to the international system International Society of Limb Salvage 2014 (ISOLS 2014). The functional result was evaluated using the international Musculoskeletal Tumor Society (MSTS) system and the Harris Orthopedic scale (Harris Hip Score) in terms of 3, 6 and 12 months. Results. The total number of complications detected during the follow-up period from 2014 to 2020 was 13 (12 %) cases. Type I complications (ISOLS 2014) were represented by dislocation of the endoprosthesis – subtype IA, which was detected in 7 (6.4 %) patients operated with bipolar heads. There were no cases of dislocation of the endoprosthesis in the group operated with the use of double mobility (p = 0.006). We were able to identify a statistically significantly better functional result in patients operated with using of double mobility at all follow-up periods, both on the MSTS scale and on the Harris scale (p = 0.004). The five-year survival rate for aggressive benign tumors and tumor-like diseases was 92 %; for malignant primary tumors – 82 %; in patients with secondary bone lesions – 60 %. Conclusion. Today, oncological hip replacement, is still lags behind in functional results from primary standard hip arthroplasty, and the number of complications is still several times higher. We consider that one of the solutions of this problem, is a wider use of acetabulum components with dual mobility in oncoortopedic practice.