Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register

ABSTRACT BACKGROUND: The dual mobility cup (DMC) was initially design in 1974. It was designed to offer additional stability in total hip arthroplasty (THA) and to prevent dislocations. The dissociation of a DMC has been termed an intraprosthetic dislocation (IPD) and is a rare complication. It is defined as separation of the articulation between the polyethylene and head articulation in the DMC. As the utilisation of DMCs in orthopaedic surgery increases, we can expect an increase in this rare complication. We report a case of an IPD in the setting of revision hip arthroplasty in a 72-year-old female. CASE REPORT: The report is on a 72-year-old female patient who underwent revision hip arthroplasty. The articulation utilised was of the dual mobility type. Some eight months later she dislocated her hip. An attempted closed reduction under general anaesthesia with muscle relaxant was unsuccessful. Thereafter she was taken to surgery to perform an open reduction of the hip. Intra-operatively it was found that the dual mobility head had dissociated, with the polyethylene component remaining in the metal liner. A revision of the components was performed. DISCUSSION: We postulate on the mechanisms of dissociation of the dual mobility head. We review the current literature related to IPD and discuss the risk factors associated with this rare complication. CONCLUSION: The diagnosis of IPD is an indication for revision surgery of the DMC. When utilising a DMC, care should be taken to mitigate against the known risk factors for IPD. All dual mobility dislocations should be reduced under general anaesthesia with muscle relaxant Level of evidence: Level 4.. Keywords: intraprosthetic dislocation, dual mobility cup, revision hip arthroplasty

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The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0038-1676637 ◽

2018 ◽

Vol 02 (04) ◽

pp. 194-204

Author(s):

Hari Parvataneni ◽

Luis Pulido ◽

Hernan Prieto ◽

Arnold Silverberg

Keyword(s):

High Risk ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Clinical Success ◽

The United States ◽

Revision Hip Arthroplasty ◽

Dual Mobility ◽

Total Hip ◽

Hip Stability

AbstractThe concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

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Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.09.020 ◽

2017 ◽

Vol 103 (1) ◽

pp. 21-25 ◽

Cited By ~ 5

Author(s):

A. Acker ◽

J.-F. Fischer ◽

K. Aminian ◽

E. Lécureux ◽

B.M. Jolles

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip ◽

Gait Parameters

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Minimum 7-Year Outcomes of Dual Mobility Acetabular Cups in Total Hip Arthroplasty Patients

The Journal of Hip Surgery ◽

10.1055/s-0040-1713109 ◽

2020 ◽

Vol 04 (02) ◽

pp. 090-093

Author(s):

John M. Tarazi ◽

Hytham S. Salem ◽

Joseph O. Ehiorobo ◽

Nipun Sodhi ◽

Luke J. Garbarino ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Study Cohort ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip ◽

Patient Reported ◽

Dual Mobility Cups ◽

Metallic Liner

AbstractModular dual mobility cups have been developed to potentially address postoperative hip instability, which can occur in nearly 20% of all revision total hip arthroplasty (THA) patients. By having a prosthetic construct that contains two points of articulation between the femoral head and liner and between the liner and shell, joint stability can be increased. The purpose of this study was to report on dual mobility cup survivorships, patient satisfaction outcomes, complications, and radiographic outcomes at a minimum 7-year follow-up. A high-volume academic surgeon performed a total of 143 consecutive dual mobility primary THAs on patients who had a minimum follow-up of 7 years (range, 7–8.5 years). The study cohort consisted of 77 females (54%) and 66 males (46%) who had a mean age of 65 years (range, 34–90 years). Aseptic, septic, and all-cause survivorship was determined by Kaplan-Meier analysis. Harris Hip Scores (HHS), postoperative complications, and radiographs were also assessed. No cup failures were observed. Overall, septic survivorship was 99.3% (95% confidence interval [CI]: 0.98–1.0) and all-cause survivorship was 98.6% (95% CI: 0.97–1.0). Two patients (1.4%) required revision surgery unrelated to the use of a modular dual mobility cup. Of these, one patient experienced femoral stem loosening and the other developed a periprosthetic infection that was treated with a two-stage revision. The mean total HHS was above 95 points at the most recent follow-up. Three patients (2.3%) experienced medical complications, including two deep vein thromboses and one for nonfatal pulmonary embolism. Radiographic evidence revealed incomplete seating of the metallic liner in one patient. Dual mobility cups were developed in an attempt to decrease the rate of instability following THA. The results from this study indicate that excellent clinical and patient-reported outcomes can be achieved at 7-year follow-up in patients who undergo THA with a dual mobility cup. Therefore, dual mobility cups appear to be an appropriate treatment option for primary THA.

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Resection of the proximal femur during one-stage revision for infected hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.103b11.bjj-2021-0022.r1 ◽

2021 ◽

Vol 103-B (11) ◽

pp. 1678-1685

Author(s):

Hussein Abdelaziz ◽

Michael Schröder ◽

Calvin Shum Tien ◽

Kahled Ibrahim ◽

Thorsten Gehrke ◽

...

Keyword(s):

Risk Factors ◽

Hip Arthroplasty ◽

Proximal Femur ◽

Sinus Tract ◽

Revision Hip Arthroplasty ◽

Time Interval ◽

Dual Mobility ◽

One Stage ◽

Increased Risk ◽

Femoral Resection

Aims One-stage revision hip arthroplasty for periprosthetic joint infection (PJI) has several advantages; however, resection of the proximal femur might be necessary to achieve higher success rates. We investigated the risk factors for resection and re-revisions, and assessed complications and subsequent re-revisions. Methods In this single-centre, case-control study, 57 patients who underwent one-stage revision arthroplasty for PJI of the hip and required resection of the proximal femur between 2009 and 2018 were identified. The control group consisted of 57 patients undergoing one-stage revision without bony resection. Logistic regression analysis was performed to identify any correlation with resection and the risk factors for re-revisions. Rates of all-causes re-revision, reinfection, and instability were compared between groups. Results Patients who required resection of the proximal femur were found to have a higher all-cause re-revision rate (29.8% vs 10.5%; p = 0.018), largely due to reinfection (15.8% vs 0%; p = 0.003), and dislocation (8.8% vs 10.5%; p = 0.762), and showed higher rate of in-hospital wound haematoma requiring aspiration or evacuation (p = 0.013), and wound revision (p = 0.008). The use of of dual mobility components/constrained liner in the resection group was higher than that of controls (94.7% vs 36.8%; p < 0.001). The presence and removal of additional metal hardware (odds ratio (OR) = 7.2), a sinus tract (OR 4), ten years’ time interval between primary implantation and index infection (OR 3.3), and previous hip revision (OR 1.4) increased the risk of proximal femoral resection. A sinus tract (OR 9.2) and postoperative dislocation (OR 281.4) were associated with increased risk of subsequent re-revisions. Conclusion Proximal femoral resection during one-stage revision hip arthroplasty for PJI may be required to reduce the risk of of recurrent or further infection. Patients with additional metalware needing removal or transcortical sinus tracts and chronic osteomyelitis are particularly at higher risk of needing proximal femoral excision. However, radical resection is associated with higher surgical complications and increased re-revision rates. The use of constrained acetabular liners and dual mobility components maintained an acceptable dislocation rate. These results, including identified risk factors, may aid in preoperative planning, patient consultation and consent, and intraoperative decision-making. Cite this article: Bone Joint J 2021;103-B(11):1678–1685.

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Severe Metallosis Owing to Intraprosthetic Dislocation in a Failed Dual-Mobility Cup Primary Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2010.11.019 ◽

2012 ◽

Vol 27 (3) ◽

pp. 493.e1-493.e3 ◽

Cited By ~ 24

Author(s):

Riazuddin Mohammed ◽

Peter Cnudde

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip ◽

Intraprosthetic Dislocation ◽

Primary Total Hip Arthroplasty

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Midterm survival analysis of a cemented dual-mobility cup combined with bone impaction grafting in 102 revision hip arthroplasties

Hip International ◽

10.5301/hipint.5000548 ◽

2017 ◽

Vol 28 (2) ◽

pp. 161-167 ◽

Cited By ~ 2

Author(s):

Elsa A. Spaans ◽

Koen L.M. Koenraadt ◽

Robert Wagenmakers ◽

Joost A.A.M. van den Hout ◽

Martijn A.J. te Stroet ◽

...

Keyword(s):

Hip Arthroplasty ◽

Dislocation Rate ◽

Control Group ◽

Impaction Grafting ◽

Dual Mobility Cup ◽

Chi Square ◽

Dual Mobility ◽

Combined Control ◽

Bone Impaction Grafting ◽

Hip Arthroplasties

Introduction: Revision hip arthroplasty is associated with higher dislocation rates than primary hip arthroplasty. A dual-mobility cup (DMC) can reduce this risk. Another problem is destruction of the acetabulum, induced by aseptic loosening of the prosthesis. Bone impaction grafting (BIG) can be used to reconstruct these defects, but is usually performed with cemented all polyethylene cups. The purpose of this study is to evaluate midterm cup survival and dislocation rate for the combination of BIG and DMC. Methods: Between 2007 and 2013, 96 patients received 102 DMCs combined with BIG of the acetabulum during revision surgery. These data were first compared with a control group, consisting of 59 cases from the same hospital receiving a cemented all polyethylene cup combined with BIG. In addition, the control group was expanded with 41 cases operated on in 2007 in ‘an orthopaedic centre of excellence’, resulting in a ‘combined control group’ of 100 patients. Log-rank tests and chi-square tests were used to compare survival and dislocation rates, respectively. Results: Cumulative survival of the DMC was 95.8% (range 3 months-7 years). This was comparable to the survival in the control groups (96.5% and 94.7%). The dislocation rate of 2.9% (3/102) in the dual-mobility group was lower (p = 0.02) compared to the dislocation rate of 11.8% (7/59) in the control group, but not (p = 0.12) compared to 8% in the combined control group (8/100). Conclusions: This study shows that combining a DMC with BIG does not compromise outcome in terms of midterm survival of the cup.

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