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

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.

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

The Journal of Hip Surgery ◽

10.1055/s-0038-1661341 ◽

2018 ◽

Vol 02 (02) ◽

pp. 088-091 ◽

Cited By ~ 1

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.

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Dual mobility constructs in revision total hip arthroplasty: survivorship analysis in recurrent dislocation versus other indications at three to twelve-year follow-up

International Orthopaedics ◽

10.1007/s00264-019-04445-4 ◽

2019 ◽

Vol 44 (2) ◽

pp. 253-260 ◽

Cited By ~ 3

Author(s):

Nicolas de l’Escalopier ◽

Valérie Dumaine ◽

Guillaume Auberger ◽

Antoine Babinet ◽

Jean-Pierre Courpied ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Recurrent Dislocation ◽

Revision Total Hip Arthroplasty ◽

Survivorship Analysis ◽

Dual Mobility ◽

Total Hip

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Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

Advances in Orthopedics ◽

10.1155/2013/347358 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Mitsuyoshi Yamamura ◽

Nobuo Nakamura ◽

Hidenobu Miki ◽

Takashi Nishii ◽

Nobuhiko Sugano

Keyword(s):

Total Hip Arthroplasty ◽

Bone Cement ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Full Weight Bearing ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Revision Tha ◽

Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

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Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

BioMed Research International ◽

10.1155/2018/2364269 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hou-Tsung Chen ◽

Cheng-Ta Wu ◽

Tsan-Wen Huang ◽

Hsin-Nung Shih ◽

Jun-Wen Wang ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Type Ii ◽

Revision Total Hip Arthroplasty ◽

Total Hip ◽

Press Fit ◽

Cementless Cup ◽

Revision Tha ◽

Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

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Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

Hip International ◽

10.1177/1120700020917125 ◽

2020 ◽

Vol 30 (1_suppl) ◽

pp. 7-11

Author(s):

Massimo Franceschini ◽

N Amir Sandiford ◽

Vincenzo Cerbone ◽

Lucio Cappelli Toledo de Araujo ◽

Daniel Kendoff

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Short Term ◽

Total Hip ◽

Antibacterial Coating ◽

Revision Tha ◽

Detailed Function ◽

New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

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Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2015.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 66-72

Author(s):

Nicholas M. Hernandez ◽

Zoe W. Hinton ◽

Christine J. Wu ◽

Paul F. Lachiewicz ◽

Sean P. Ryan ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Revision ◽

Revision Total Hip Arthroplasty ◽

Dual Mobility ◽

Revision Thas ◽

Revision Tha ◽

Acetabular Components ◽

Acetabular Loosening

Aims Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim of this study, therefore, was to evaluate the outcomes in a cohort of patients in whom MDM components were used at revision THA, with a mean follow-up of more than five years. Methods Using the database of a single academic centre, 126 revision THAs in 117 patients using a single design of an MDM acetabular component were retrospectively reviewed. A total of 94 revision THAs in 88 patients with a mean follow-up of 5.5 years were included in the study. Survivorship was analyzed with the endpoints of dislocation, reoperation for dislocation, acetabular revision for aseptic loosening, and acetabular revision for any reason. The secondary endpoints were surgical complications and the radiological outcome. Results The overall rate of dislocation was 11%, with a six-year survival of 91%. Reoperation for dislocation was performed in seven patients (7%), with a six-year survival of 94%. The dislocations were early (at a mean of 33 days) in six patients, and late (at a mean of 4.3 years) in four patients. There were three intraprosthetic dissociations. An outer head diameter of ≥ 48 mm was associated with a lower risk of dislocation (p = 0.013). Lumbrosacral fusion was associated with increased dislocation (p = 0.004). Four revision THAs (4%) were further revised for aseptic acetabular loosening, and severe bone loss (Paprosky III) at the time of the initial revision was significantly associated with further revision for aseptic acetabular loosening (p = 0.008). Fourteen acetabular components (15%) were re-revised for infection, and a pre-revision diagnosis of reimplantation after periprosthetic joint infection (PJI) was associated with subsequent PJI (p < 0.001). Two THAs had visible metallic changes on the backside of the cobalt chromium liner. Conclusion When using this MDM component in revision THA, at a mean follow-up of 5.5 years, there was a higher rate of dislocation (11%) than previously reported. The size of the outer bearing was related to the risk of dislocation. There was a low rate of aseptic acetabular loosening. Longer follow-up of this MDM component and evaluation of other designs are warranted. Cite this article: Bone Joint J 2021;103-B(7 Supple B):66–72.

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

Journal of Orthopaedic Surgery ◽

10.1177/2309499018783913 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878391 ◽

Cited By ~ 3

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.

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

The Duke Orthopaedic Journal ◽

10.5005/jp-journals-10017-1064 ◽

2016 ◽

Vol 6 (1) ◽

pp. 17-20 ◽

Cited By ~ 1

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.

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Revision total hip arthroplasty using the Kerboull acetabular reinforcement device for Paprosky type III defects involving the inferior margin of the acetabulum

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1472.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 725-732 ◽

Cited By ~ 4

Author(s):

E. Gibon ◽

N. Barut ◽

J-P. Courpied ◽

M. Hamadouche

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Revision Total Hip Arthroplasty ◽

Inferior Margin ◽

Total Hip ◽

Type Iii ◽

Revision Tha ◽

Reinforcement Device

Aims The purpose of this retrospective study was to evaluate the minimum five-year outcome of revision total hip arthroplasty (THA) using the Kerboull acetabular reinforcement device (KARD) in patients with Paprosky type III acetabular defects and destruction of the inferior margin of the acetabulum. Patients and Methods We identified 36 patients (37 hips) who underwent revision THA under these circumstances using the KARD, fresh frozen allograft femoral heads, and reconstruction of the inferior margin of the acetabulum. The Merle d’Aubigné system was used for clinical assessment. Serial anteroposterior pelvic radiographs were used to assess migration of the acetabular component. Results At a mean follow-up of 8.2 years (5 to 19.3), the mean Merle d’Aubigné score increased from 12.5 (5 to 18) preoperatively to 16.5 (10 to 18) (p < 0.0001). The survival rate at ten years was 95.3% (sd 4.5; 95% confidence interval (CI) 86.4 to 100) and 76.5% (sd 9.9, 95% CI 57.0 to 95.9) using aseptic loosening and radiological loosening as the endpoints, respectively. Conclusion These results show that the use of the KARD with reconstruction of the inferior margin of the acetabulum in revision THA is associated with acceptable clinical results and survival at mid-term follow-up with, however, a high rate of migration of the acetabular component of 21.6%. Cite this article: Bone Joint J 2018;100-B:725–32.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211397 ◽

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

Background: 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.Methods: 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.Results: 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.Conclusions: The DMC is an effective solution for the management of high-risk cases undergoing total hip replacement to reduce the incidence of postoperative instability.

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