Do Cemented Dual-Mobility Cups Confer Stability for Patients at High Risk of Dislocation in Revision Total Hip Arthroplasty?

2018 ◽  
Vol 02 (02) ◽  
pp. 088-091 ◽  
Author(s):  
Perry Evangelista ◽  
Kamil Okroj ◽  
Darren Plummer ◽  
Craig Della Valle ◽  
Ran Schwarzkopf
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Cup ◽  
Metal Shell ◽  
Dual Mobility ◽  
Total Hip

AbstractDislocation is among the most commonly reported complications following revision total hip arthroplasty. Dual-mobility bearings may lower the risk of dislocation. The authors report the results of a multicenter study evaluating the use of a dual-mobility acetabular cup design that was cemented into a metal shell as part of complex acetabular reconstructions or in cases where the risk of dislocation was felt to be high, such as isolated bearing exchanges. Eighteen patients were identified for being at high risk of dislocation who underwent cementation of a dual-mobility shell that is specifically made for cementation, into a fully porous metal revision acetabular cup (10 patients) or into a well-fixed cup at the time of revision without removal of the existing acetabular component (eight patients). Patients were assessed clinically and radiographically at a minimum of 2 years for the evidence of dislocation, revision surgery, and implant loosening. At a mean of 36 months (range, 25–56 months), one patient died and one was lost to follow-up. There were no known cases of hip dislocation. There was one repeat revision, for a deep infection treated with irrigation and debridement. The mean preoperative Harris Hip Score of 46 (range, 40–79) improved to a mean of 65 points (range, 41–97) at the most recent evaluation. Acetabular components were retained in 8 out of 18 cases and the dual-mobility shell was cemented into it. Cementation of a dual-mobility cup into a shell at the time of a revision surgery is a safe and reliable construct at minimum of 2 years for patients at high risk of dislocation. There were no complications related to the cementation of the cup into the metal shell. Longer follow-up is required to further assess the durability of this construct.

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

2019 ◽  
pp. 112070001987361 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Xabier Foruria ◽  
Ioar Urra ◽  
Urko Aguirre ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

Safety and Efficacy of Hemispherical with Flattened Pole Dual-Mobility Acetabular Cup in Revision or Complex Hip Arthroplasty: The SYMCOR-2 study

2020 ◽  
Author(s):  
Gilles Estour ◽  
Nicolas Bonin ◽  
Schneider Loïc ◽  
Olivier Guyen ◽  
Frederic Christopher Daoud
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cobalt Chromium ◽  
Sampling Frame ◽  
Acetabular Cup ◽  
Short Term ◽  
Dual Mobility ◽  
Safety And Efficacy ◽  
Total Hip

Abstract Background: This study estimated the short-term clinical safety and efficacy of hemispherical with flattened pole cobalt-chromium metal-back dual-mobility acetabular cup with porous outer hydroxyapatite coating and anchoring screw and pods (HFPC-DMR-HA) or cement fixation (HFPC-DM-CEM), in revision or complex total hip arthroplasty.Methods: Single-center retrospective observational cohort study of consecutively operated patients who underwent THA with an HFPC-DMR-HA or HFPC-DM-CEM cup 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires.Results: Sampling frame: 203 patients including 9.85% in the two cohorts with 15 HFPC-DMR-HA and 5 HFPC-DM-CEM. 3 (20%) and 2 (40%) patients were lost to follow-up, respectively. Median age was 85.6 years (range: 45.1 ; 93.3) and 78.8 (range: 68.8 ; 86.9). Median follow-up (years): HFPC-DMR-HA: 2.3, HFPC-DM-CEM: 3.3. Clinical indications: HFPC-DMR-HA 67% revision & 33% primary THAs, HFPC-DM-CEM 100% revision. Primary endpoint: 2-year implant survival rate: HFPC-DMR-HA 93% [59, 99], HFPC-DM-CEM 100%. Prosthetic dislocation: HFPC-DMR-HA 1 (6.7%), HFPC-DM-CEM 0%. Secondary endpoint: Modified HHS (pain & functional subscore) improved with HFPC-DMR-HA from baseline 26.8 [14.9, 38.7] to 82.2 [73.5, 90.9] at 2-year follow-up (p<0.0001); HFPC-DM-CEM from 41.6 [24.9, 58.3] to 80.7 [55.8, 100].Conclusions: The authors deemed the short-term outcomes with these acetabular cups in revision or complex total hip arthroplasty to be satisfactory.Study registration: clinicaltrials.gov NCT04209426.

scholarly journals Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878391 ◽  
Author(s):  
Jun-Dong Chang ◽  
In-Sung Kim ◽  
Sameer Ajit Mansukhani ◽  
Vishwas Sharma ◽  
Sang-Soo Lee ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fourth Generation ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Revision Tha ◽  
Ceramic On Ceramic

Purpose: The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. Methods: A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0–9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. Results: At the final follow-up examination, the average HHS was 90.4 (range, 67–100). The average WOMAC pain and physical function score were 2.8 (range, 0–12) and 16.4 (range, 0–42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. Conclusion: Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.

scholarly journals Safety and Efficacy of Hemispherical with Flattened Pole Dual-Mobility Acetabular Cup in Primary Hip Arthroplasty: The SYMCOR-1 study

2020 ◽  
Author(s):  
Nicolas Bonin ◽  
Gilles Estour ◽  
Jean-Emmanuel Gedouin ◽  
Olivier Guyen ◽  
Frederic Christopher Daoud
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cobalt Chromium ◽  
Acetabular Cup ◽  
Short Term ◽  
Dual Mobility ◽  
Safety And Efficacy ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Abstract Background: This study estimated the short-term clinical safety and efficacy of hemispherical with flattened pole cobalt-chromium metal-back with porous outer hydroxyapatite coating dual-mobility acetabular cup (HFPC-DM-HA) in primary total hip arthroplasty.Methods: Single-center retrospective observational cohort study of consecutive patients undergoing total hip arthroplasty with a HFPC-DM-HA 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires.Results: Sampling frame: 361 patients including 59 patients (16.3%) in the cohort. 6 patients (10%) lost to follow-up. Median age 77.5 years (range: 67 ; 92), 32% female, median BMI 25.2 kg.m-2 (18.4 to 56.8). Clinical indications: Primary THA in all patients, resulting from primary osteoarthritis in 80% of them. Median follow-up 3.0 years (2.7 to 4.1). Primary endpoint: 2-year implant survival rate: 97% [87, 99]. Prosthetic dislocation: 0%. Secondary endpoint: Modified HHS (pain & functional subscore) improved from baseline 39.7 [34.6, 44.7] to 75.8 [72.1, 79.6] at 1-year and to 86.7 [83.7, 89.7] at 2-year follow-up (p<0.0001).Conclusions: The authors deemed the short-term outcomes of this acetabular cup in primary total hip arthroplasty to be satisfactory.Study registration: clinicaltrials.gov NCT04209374.

scholarly journals Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component

2016 ◽  
Vol 6 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Samuel S Wellman ◽  
David E Attarian ◽  
Taylor R McClellan ◽  
Roberto D Calderon ◽  
Paul F Lachiewicz
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Dislocation Rate ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Dual Mobility ◽  
Total Hip ◽  
Increased Risk

ABSTRACT Patients undergoing a revision total hip arthroplasty (THA) are at increased risk for dislocation. The literature suggests dual-mobility components may decrease the frequency of dislocation. We conducted a retrospective study of one type of dual mobility acetabular component implanted in 82 revision THA cases that were considered at increased risk for dislocation. Of the 82 hips, 58 had a mean follow-up of 12 months (3–28 months). The indication for revision was instability in 18 hips (31%), adverse metal-on-metal reaction in 13 hips (22%), reimplantation for infection in 11 hips (19%), and aseptic loosening of the acetabular component in 9 hips (16%). In the course of follow-up, 6 hips developed a deep infection requiring reoperation. There were no early hip dislocations. McClellan TR, Calderon RD, Bolognesi MP, Attarian DE, Lachiewicz PF, Wellman SS. Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component. The Duke Orthop J 2016;6(1):17-20.

scholarly journals High risk of hip dislocation following polyethylene liner exchange in total hip arthroplasty—is cup revision necessary?

2020 ◽  
Vol 140 (11) ◽  
pp. 1837-1845
Author(s):  
D. Dammerer ◽  
F. Schneider ◽  
T. Renkawitz ◽  
D. Putzer ◽  
M. Bogensperger ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Hip Dislocation ◽  
Polyethylene Liner ◽  
Acetabular Cup ◽  
Total Hip ◽  
Risk Increase ◽  
Cup Revision

Abstract Purpose Polyethylene (PE) wear remains a common reason for revision surgery following total hip arthroplasty (THA). An established treatment method is isolated liner exchange in a well-fixed acetabular cup and entails a known high risk of hip dislocation after revision surgery. The purpose of this retrospective study was to determine the rate of hip dislocation after liner exchange. Methods Patients were included if (1) the PE liner was removable, (2) the acetabular shell was stable with acceptable orientation, (3) no osteolysis around the acetabular cup was found and (4) no dislocation of the THA occurred before revision surgery. We reviewed medical histories and performed radiological measurements using Einzel-Bild-Röntgen-Analyse (EBRA) software. EBRA measurements and statistical investigations were performed by two independent investigators. Results A total of 82 patients were included in our study. Mean follow-up was six (range: 3.6–9.9) years. In 13 (15.8%) patients THA dislocations occurred at a mean postoperative period of 20.2 (range: 1–44) weeks after revising the PE liner. This is equivalent to an absolute risk increase of 16% after revision surgery, which results in a number needed to harm of 6. This means that every sixth patient with isolated liner exchange can expect to experience dislocation due to wear. Conclusion In conclusion, isolated exchange of the polyethylene liner because of wear showed a high risk of dislocation and further cup revision. Our results suggest that the threshold for revising well-fixed components in the case of liner wear should be lowered. Trial Registration number and date of registration Number: 20140710-1012 and Date: 2016-03-09.

scholarly journals Outcome of dual mobility total hip arthroplasty in patients who are at high risk for dislocation

2021 ◽  
Author(s):  
Basavaraj S. Kyavater ◽  
Rafeeq M. D. ◽  
Sathish Kumar ◽  
Hemanth P. Hallinalli
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Total Hip Replacement ◽  
Hip Arthroplasty ◽  
Hip Replacement ◽  
Hip Dislocation ◽  
Dual Mobility ◽  
Total Hip ◽  
A Prospective Study

<p><strong>Background: </strong>Dislocation after total hip arthroplasty (THA) remains a major concern, because it is reported to range from 1% to 5%. The concept of dual mobility articulation was developed in 1970 by Bousquet to decrease dislocation risk. Several studies have looked at the outcome of dual mobility articulation in primary THA and in revision THA.<strong></strong></p><p><strong>Methods: </strong>This is a prospective study of 33 patients undergoing dual mobility THA during 24 months period from October 2017 to September 2019. Patients undergoing total hip replacement (THR) to have dual mobility cup (DMC) were those at high risk of dislocation. Patients were followed up for a mean period of 18 months.<strong></strong></p><p><strong>Results: </strong>33 patients (mean age 67 years) underwent DMC THA. 27 patients underwent primary hip replacement. The follow-up of our cases has ranged from 13 months to 3 years with a mean follow-up of 18 months. none of the patients had hip dislocation.</p><p><strong>Conclusions</strong>: The DMC is an effective solution for the management of high-risk cases undergoing total hip replacement to reduce the incidence of postoperative instability.</p>

scholarly journals Cemented Dual Mobility Cup for Primary Total Hip Arthroplasty in Elder Patients with High-Risk Instability

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 23
Author(s):  
José María Lamo-Espinosa ◽  
Jorge Gómez-Álvarez ◽  
Javier Gatica ◽  
Álvaro Suárez ◽  
Victoria Moreno ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Demographic Data ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Total Hip ◽  
Elder Patients

Several studies have shown that double mobility (DM) cups reduce postoperative dislocations. Does the cemented dual mobility cup reduce dislocations in a specific cohort of elder patients with a high dislocation risk? Our hypothesis is that this implant is optimal for elder patients because it reduces early dislocation. We have retrospectively reviewed elder patients who underwent total hip arthroplasty (THA) with cemented double mobility cup between March 2009 and January 2018. The inclusion criteria were patients (>75 years) who were operated on for primary THA (osteoarthritis or necrosis) with a cemented dual mobility cup and a high-risk instability (at least two patient-dependent risk factors for instability). The exclusion criteria were revision surgeries or hip fracture. In all the cases, the same surgical approach was performed with a Watson Jones modified approach in supine position. We have collected demographic data, instability risk factors. Patients were classified using the Devane’s score, Merle d’Aubigné score and the patient’s likelihood of falling with the Morse Fall Scale. Surgical and follow-up complications were collected from their medical history. Sixty-eight arthroplasties (68 patients) were included in the study. The median age was 81.7 years (SD 6.4), and the American Society of Anesthesiologists (ASA) score showed a distribution: II 27.94%, III 63.24% and IV 8.82%. Devane’s score was less than five in all of the cases. At least two patient-dependent risk factors for instability (87% had three or more) were present in each case. The median follow-up time was 49.04 months (SD 22.6). Complications observed were two cases of infection and one case of aseptic loosening at 15 months which required revision surgery. We did not observe any prosthetic dislocation. The cemented dual mobility cup is an excellent surgical option on primary total hip arthroplasties for elder patients with high-risk instability.

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