Comparing Stability, Gait, and Functional Score after 40-mm Dual-Mobility Hip Arthroplasty to 36-mm Head Hip Arthroplasty in Elderly Hip Fracture Patients

초록

Background: This study aimed to compare the intraoperative stability and early clinical outcomes of 40-mm diameter dual mobility (DM)-total hip arthroplasty (THA) with 36-mm ceramic head (large head) THA in active elderly patients with hip fractures. Methods: A prospective randomized controlled trial was conducted from May 2022 to December 2022. Inclusion criteria were as follows: age >= 60 years, displaced femoral neck fracture, Koval grade 1 or 2, planned 54-mm acetabular component, and over 1-year follow-up. Intraoperative stability tests were performed on all patients (internal rotation at 45 degrees, 60 degrees, and 90 degrees of hip fracture). Functional outcomes (Harris Hip Score and University of California, Los Angeles [UCLA] Score) were evaluated at 6 weeks and 3 months postoperatively. Gait analysis using artificial intelligence (AI) techniques was conducted at 3 months postoperatively. Results: The study included 36 DM-THA patients (mean age, 69.6 +/- 2.2 years; 44% women) and 37 large head THA patients (mean age, 69.6 +/- 1.2 years; 64% women). No statistically significant differences were observed in functional outcomes and hip range of motion between the 2 groups. However, there was a significant difference in the gait speed and stance-swing phase of the large head THA group and the DM-THA group: the DM-THA group demonstrated superior gait speed (2.85 +/- 0.83 kph vs. 2.04 +/- 1.04 kph, p = 0.003) and higher stance phase ratios (operated side: 63.57% +/- 3.82% vs. 48.19% +/- 5.50%, p < 0.001; opposite side: 62.77% +/- 2.27% vs. 49.93% +/- 6.94%, p < 0.001). In the stability test at 90 degrees of hip flexion, the DM-THA group had a measurement of 48.40 degrees +/- 5.17 degrees, while the large head THA group had a measurement of 30.94 degrees +/- 2.98 degrees (p = 0.012). Despite the lack of statistical significance, the intraoperative stability test showed the dislocation angle was notably different between the groups in the hip flexion position of 60 degrees (51.60 degrees +/- 6.09 degrees in the DM-THA group and 40.00 degrees +/- 2.80 degrees in the large head THA group, p = 0.072). Conclusions: Superior results were observed in the intraoperative stability test and early recovery of gait after DM-THA compared to large head THA. We believe that DM-THA can be a useful surgical option for THA in elderly patients with hip fractures.

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