The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

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.

Long-term results of tripolar constrained total hip arthroplasty in revision hip arthroplasty

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 123-126 ◽  
Author(s):  
M. El-Husseiny ◽  
B. Masri ◽  
C. Duncan ◽  
D. S. Garbuz
Keyword(s):  
At Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Hip Arthroplasty ◽  
Long Term Results ◽  
Total Hip ◽  
Patients At Risk ◽  
Patient At Risk

AimsWe investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.Patients and MethodsWe retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications.ResultsAt ten years, the Kaplan–Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners.ConclusionConstrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123–126.

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.

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.

scholarly journals Hip Stability Parameters with Dual Mobility, Modular Dual Mobility and Fixed Bearing in Total Hip Arthroplasty: an Analytical Evaluation.

2021 ◽  
Author(s):  
Domenico Tigani ◽  
Lorenzo Banci ◽  
Riccardo Valtorta ◽  
Luca Amendola
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
3D Models ◽  
Stability Parameters ◽  
Dual Mobility ◽  
Center Of Rotation ◽  
Total Hip ◽  
Press Fit ◽  
Hip Stability

Abstract Background. Use of dual mobility in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility systems were introduced to give the possibility to use dual mobility with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation changed with modular dual mobility. The objective of this study was to evaluate, through analythical simulation, how jumping distance and center of rotation change between dual mobility and standard cup with modular dual mobility or fixed bearings. Methods. 3D-models of dual mobility and standard press-fit cups with modular dual mobility or fixed bearings liners were used to simulate dual mobility, modular dual mobility and fixed bearings implant configurations, matched for same cup size, according to same cup position, different femoral head diameters. Jumping distance was calculated and center of rotation lateralization was measured for different sizes.Results. Jumping distance with modular dual mobility was reduced by -3.9mm to -8.6mm in comparison with dual mobility, from 48 to 64mm sizes. Jumping distance with modular dual mobility resulted comparable to jumping distance with polyethylene fixed bearings with Ø36mm femoral head but increased by +1.1mm and +1.4mm than jumping distance with ceramic fixed bearings with Ø36 and Ø40mm femoral heads for sizes >54mm. Modular dual mobility lateralized the center of rotation up to +2.5mm and +4.0mm in comparison with dual mobility and fixed bearings, respectively. Conclusions. Jumping distance with modular dual mobility resulted lower than dual mobility and comparable to fixed bearings polyethylene liner with Ø36mm femoral head for larger sizes. Modular dual mobility lateralized the center of rotation in comparison with both dual mobility and fixed bearings cups.

scholarly journals Hip Stability Parameters with Dual Mobility, Modular Dual Mobility and Fixed Bearing in Total Hip Arthroplasty: an Analytical Evaluation

2021 ◽  
Author(s):  
Domenico Tigani ◽  
Lorenzo Banci ◽  
Riccardo Valtorta ◽  
Luca Amendola
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
3D Models ◽  
Stability Parameters ◽  
Dual Mobility ◽  
Center Of Rotation ◽  
Total Hip ◽  
Press Fit ◽  
Hip Stability

Abstract Background. Use of dual mobility in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility systems were introduced to give the possibility to use dual mobility with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation changed with modular dual mobility. The objective of this study was to evaluate, through analytical simulation, how jumping distance and center of rotation change between dual mobility and standard cup with modular dual mobility or fixed bearings. Methods. 3D-models of dual mobility and standard press-fit cups with modular dual mobility or fixed bearings liners were used to simulate dual mobility, modular dual mobility and fixed bearings implant configurations, matched for same cup size, according to same cup position, different femoral head diameters. Jumping distance was calculated and center of rotation lateralization was measured for different sizes.Results. Jumping distance with modular dual mobility was reduced by -3.9mm to -8.6mm in comparison with dual mobility, from 48 to 64mm sizes. Jumping distance with modular dual mobility resulted comparable to jumping distance with polyethylene fixed bearings with Ø36mm femoral head but increased by +1.1mm and +1.4mm than jumping distance with ceramic fixed bearings with Ø36 and Ø40mm femoral heads for sizes >54mm. Modular dual mobility lateralized the center of rotation up to +2.5mm and +4.0mm in comparison with dual mobility and fixed bearings, respectively. Conclusions. Jumping distance with modular dual mobility resulted lower than dual mobility and comparable to fixed bearings polyethylene liner with Ø36mm femoral head for larger sizes. Modular dual mobility lateralized the center of rotation in comparison with both dual mobility and fixed bearings cups.Trial Registration. Not applicable.

scholarly journals Dual mobility in primary total hip arthroplasty: current concepts

2019 ◽  
Vol 4 (11) ◽  
pp. 640-646 ◽  
Author(s):  
Rory Cuthbert ◽  
James Wong ◽  
Philip Mitchell ◽  
Parag Kumar Jaiswal
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
High Risk Patient ◽  
Femoral Neck Fractures ◽  
Risk Patient ◽  
Functional Improvement ◽  
Dual Mobility ◽  
Total Hip

Total hip arthroplasty (THA) is one of the most successful surgical procedures – reducing pain and providing functional improvement. However, THA instability is a disabling condition and remains the most common indication for revision THA. To combat the risk of instability, the concept of dual mobility (DM) was developed. This article provides a comprehensive review of DM in the literature. Widespread use of first-generation DM was limited due to concern regarding wear of the polyethylene head and the unique complication of intraprosthetic dislocation (IPD). Implant modifications using highly cross-linked, durable polyethylene and a smooth, cylindrical femoral neck have all but eliminated IPD in contemporary DM. In multiple studies, DM demonstrates statistically significant reductions in dislocation rates comparative to standard bearing primary THA. These results have been particular promising in high-risk patient populations and femoral neck fractures – where low dislocation rates and improved functional outcomes are a recurrent theme. From an economic perspective, DM is equally exciting – with lower accrued costs and higher accrued utility comparative to standard bearing THA. Longer-term clinical evidence and higher-quality prospective comparative studies are required to strengthen current research. Dual mobility may well represent the future gold standard for THA in high-risk patient populations and femoral neck fractures, but due diligence of long-term performance is needed before recommendations for widespread use can be justified. Cite this article: EFORT Open Rev 2019;4:640-646. DOI: 10.1302/2058-5241.4.180089

scholarly journals Total hip arthroplasty

2012 ◽  
Vol 140 (5-6) ◽  
pp. 379-384
Author(s):  
Nemanja Slavkovic ◽  
Zoran Vukasinovic ◽  
Zoran Bascarevic ◽  
Boris Vukomanovic
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Preoperative Evaluation ◽  
Total Hip ◽  
Hip Stability ◽  
Fixation Techniques ◽  
Hip Arthroplasties ◽  
Primary Total Hip Arthroplasty

Total hip arthroplasty is most common reconstructive hip procedure in adults. In this surgery we replace some parts of the upper femur and acetabulum with biocompatible materials. The main goal of this surgery is to eliminate pain and regain full extent of joint motion, maintaining hip stability. Surgical technique, biomaterials, design of the prosthesis and fixation techniques have evolved with time adjusting to each other. After total hip arthroplasty patients? quality of life should be improved. There are many various postoperative complications. Some of them are fatal, and some are minor, which may become manifested years after surgery. Each next surgical procedure following previous hip surgery is associated with considerably lower chances to be successful. Therefore, in primary total hip arthroplasty, preoperative evaluation and preparation of patients are essential. Every orthopaedic surgeon needs to improve already adopted surgical skills applying them with precision and without compromise, with the main goal to achieve long-term durability of the selected implant. The number of total hip arthroplasties will also increase in future, and newer and higher quality materials will be used.

Primary total hip arthroplasty: mid-term outcomes of dual-mobility cups in patients at high risk of dislocation

2019 ◽  
pp. 112070001988903 ◽  
Author(s):  
Chahine Assi ◽  
Hanane Barakat ◽  
Jad Mansour ◽  
Camille Samaha ◽  
Kaissar Yammine
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acute Infection ◽  
Dual Mobility ◽  
Total Hip ◽  
Dual Mobility Cups ◽  
The Impact ◽  
Primary Total Hip Arthroplasty

Introduction: Dual-mobility cups (DMC) are currently used in patients having risk factors of instability. Most of the studies report the use of DMC in patients having a single high-risk variable. The aim of the study was to analyse a continuous series of patients treated with primary total hip arthroplasty (THA) and DMC with different high risk for dislocation. Methods: This is a retrospective study analysing the outcomes of primary THA with DMC in patients at high-risk of dislocation. The sample consisted of 215 patients having 1 of 3 aetiologies or risk factors: (1) young subjects (<55 years); (2) osteonecrosis of the femoral head (ONFH); and (3) femoral neck fracture (FNF). Results: With a mean follow-up duration of 70 ± 24.7 months, the findings showed the following: 2 patients had dislocated their hip following motor vehicle accidents; 1 patient had a traumatic femoral peri-prosthetic fracture; and 1 patient had an acute infection. No intra-prosthetic dislocation or aseptic loosening were encountered. No radiolucent lines were observed on the acetabular side. The mean modified Hip Harris Score was 96.6 ± 7.4%. Out of 186 patients, 170 (90.1%) would label their operated hip as a “forgotten hip”. 78 out of the 84 patients (92.8%) who used to practice oriental sitting and/or ablution for prayers were able to return to their usual daily activities of extreme hip position and 74 out of the 84 patients (88%) described their operated hip as “a forgotten hip”. No correlation was found between any of the studied variables. Discussion: The findings of this series of patients at high risk of dislocation showed excellent clinical and radiological results with very few complications. The use of DMC seems to counteract the impact of some aetiologies/risk factors that could lead to higher instability. Most patients practising extreme hip positions resumed their usual practices.

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>

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