scholarly journals Modular dual-mobility cups using ceramic liners: an original solution for selected indications?

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 59-65
Author(s):  
Rocco D’Apolito ◽  
Guido Bandettini ◽  
Filippo Maria Piana Jacquot ◽  
Luigi Zagra
Keyword(s):  
High Risk ◽  
Consecutive Series ◽  
Cobalt Chromium ◽  
Original Solution ◽  
Dual Mobility ◽  
Number Of Patients ◽  
Revision Tha ◽  
Ceramic Liner ◽  
Dual Mobility Cups ◽  
The Mean

Background: Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently “off-label” use. Patients and methods: This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. Results: 5 patients received the ceramic liner in the study period (2014–2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63–82) years, the mean follow-up was 36 (12–72) months. No dislocation occurred, and no adverse events related to the implant were recorded. Conclusions: The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency

2018 ◽  
Vol 28 (5) ◽  
pp. 491-497 ◽  
Author(s):  
Vahit E Ozden ◽  
Goksel Dikmen ◽  
Burak Beksac ◽  
Remzi Tozun
Keyword(s):  
Acetabular Reconstruction ◽  
Dual Mobility Cup ◽  
Survivorship Analysis ◽  
Dual Mobility ◽  
Total Hip ◽  
Kaplan Meier ◽  
Dual Mobility Cups ◽  
The Mean ◽  
Cemented Cup

Introduction: The purpose of this study was to summarise the performance of dual-mobility cup systems for revision total hip arthroplasty in patients with abductor-trochanteric complex deficiency. Methods: We prospectively followed 17 patients (20 hips) with a mean age of 64.5 years (range 33-89 years) who underwent acetabular reconstruction with dual-mobility cups for aseptic loosening in 12 hips, infection treatment as second or single stage in 6 hips, and instability in 2 hips. All of the patients had abductor insufficiency. We evaluated the clinical Harris Hip scores (HHS) and radiographs for migration, loosening, and osteolysis. The survival of the components was calculated according to Kaplan-Meier survivorship analysis, and failure was defined as any dislocation, acetabular component or total hip revision for any reason. Results: The mean duration of follow-up was 38.1 months (range 24-98 months). There were 2 (12.5%) revisions for cemented cup migration after 11 months and 19 months respectively. There were no dislocations. At the last follow-up, the mean HHS increased from 42 points preoperatively to 86 points. The cumulative survival rate of the dual-mobility cup system was 93% (95% confidence interval 88-98.7%) at 5 years, with any revision as the end point. Conclusion: Dual-mobility cups may provide excellent stability in patients with abductor-trochanteric complex insufficiency.

The use of dual-mobility bearings in patients at high risk of dislocation

2019 ◽  
Vol 101-B (1_Supple_A) ◽  
pp. 41-45 ◽  
Author(s):  
C. W. Jones ◽  
I. De Martino ◽  
R. D’Apolito ◽  
A. A. Nocon ◽  
P. K. Sculco ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
High Risk ◽  
High Body Mass Index ◽  
High Volume ◽  
Consecutive Series ◽  
Dual Mobility ◽  
Radiographic Outcomes ◽  
Stable Reconstruction

Aims Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. Materials and Methods We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. Results There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations. Conclusion At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.

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.

scholarly journals Failure in the application of fragility fracture prevention guidelines

2014 ◽  
Vol 96 (5) ◽  
pp. 381-385 ◽  
Author(s):  
MH Elvey ◽  
H Pugh ◽  
G Schaller ◽  
G Dhotar ◽  
B Patel ◽  
...  
Keyword(s):  
Hip Fracture ◽  
High Risk ◽  
Fragility Fracture ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Consecutive Series ◽  
National Guidelines ◽  
Fracture Population ◽  
The Mean ◽  
The Uk

Introduction The cost of fragility fractures to the UK economy is predicted to reach £2.2 billion by 2025. We studied our hip fracture population to establish whether national guidelines on fragility fracture prevention were being followed, and whether high risk patients were identified and treated by local care services. Methods Data on a consecutive series of trauma hip fracture admissions were collected prospectively over 14 months. National Institute for Health and Care Excellence (NICE) and National Osteoporosis Guideline Group (NOGG) recommendations and FRAX® risk calculations were applied to patients prior to their admission with a new hip fracture. Results Overall, 94 patients were assessed against national guidelines. The mean population age was 77 years. Almost a quarter (22%) of patients had suffered a previous fragility fracture. The mean FRAX® ten-year probability of hip fracture was 7%. According to guidelines, 45% of the study population required treatment, 35% fulfilled criteria for investigation and reassessment, and 20% needed no further management. In practice, 27% received treatment, 4% had undergone dual energy x-ray absorptiometry and were untreated, and 69% had not been investigated and were untreated. In patients meeting intervention thresholds, only 33% of those who required treatment were receiving treatment in practice. Conclusions In conjunction with NICE and NOGG recommendations, FRAX® was able to identify 80% of our fracture population as intermediate or high risk on the day of fracture. Correct management was evident in a third of cases with a pattern of inferior guideline compliance seen in a London population. There remains a lack of clarity over the duty of care in fragility fracture prevention.

Good mid-term clinical results of a cemented dual mobility cup: a single-centre experience

2017 ◽  
Vol 28 (1) ◽  
pp. 59-62 ◽  
Author(s):  
Gregor Kavčič ◽  
Pika Mirt ◽  
Klemen Bedenčič
Keyword(s):  
Final Analysis ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Consecutive Series ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Single Centre Experience ◽  
The Mean ◽  
Hip Arthroplasties

Introduction and methods: From January 2004 to December 2008, 188 total hip arthroplasties were performed using a cemented dual mobility cup. 174 patients were available for final analysis. Their mean age was 76.8 (range 54-98 years). The mean follow-up was 7.7 years (range 5-10 years). Results: There were no dislocations. Survivorship rates of the femoral and acetabular components were 100% at a minimum of 5 years. At the latest follow-up, the mean Harris Hip Score significantly increased from 31.6 (only arthritic patients) points preoperatively to 84.5 points. No patients had progressive osteolysis, component migration, or loosening on radiographs. 2 patients presented with periprosthetic fractures treated conservatively. 2 patients presented with infection treated without implant removal and 1 patient presented with transient femoral palsy. Conclusions: The results of this consecutive series confirmed the good performance of the cemented dual mobility cup at mean 7.7 years follow-up with no revision and no dislocations.

scholarly journals Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Ping Keung Chan ◽  
Sum Lik Cheung ◽  
Kar Hei Lam ◽  
Wing Chiu Fung ◽  
Vincent Wai Kwan Chan ◽  
...  
Keyword(s):  
High Risk ◽  
Hip Dislocation ◽  
Harris Hip Score ◽  
Acetabular Cup ◽  
Widespread Application ◽  
Dual Mobility ◽  
Asian Populations ◽  
Asian Patients ◽  
High Risk Factor ◽  
The Mean

Abstract Background Dual-mobility hip component is widely used in Europe and North America, because it effectively reduces hip dislocation in primary and revision total hip arthroplasties. However, reports were limited on the use of dual-mobility articulation in Asian populations. Purpose The aim of this retrospective study was to review the use of modular dual-mobility hip articulation in Asian patients with the high risk factor for hip dislocation. We also discussed the potential concern on the use of dual-mobility articulation in Asian patients. Methods From Jan 2018 to June 2019, 17 patients were included in this study. The mean age of the patients was (73.8 ± 9.5) years (range: 57–88 years). The mean size of acetabular cup and modular DM liner were (49.5 ± 3.4) mm (range, 46–58 mm) and (40.7 ± 3.4) mm (range, 38–48 mm), respectively. The mean follow-up period was (15.8 ± 3.9) months (range, 11–24 months). The primary outcome was the rate of hip dislocation. The secondary outcomes included the Harris Hip Score. Differences were considered statistically significant at p < 0.05. Results Hip dislocation, loosening, peri-prosthetic fractures, or intra-prosthetic dislocation was not found in the series. The mean preoperative and postoperative Harris Hip Scores were 42.2 ± 17.2 (range, 15–80) and 74.7 ± 13.5 (range, 52–97), respectively, giving a mean improvement of 32.5 ± 17.2 (range, 4–72). The improvement was statistically significant (p < 0.05). Conclusions In Asian patients with high risk of hip dislocation, the use of modular dual-mobility hip component produces promising outcomes without hip dislocation, but the relatively small-sized acetabulum may limit it widespread application in other populations worldwide. Trial registration HKUCTR-2913.

scholarly journals Wick technique in subscleral and subconjunctival Ologen™ implantation with trabeculectomy in patients with high risk of failure

2021 ◽  
Vol 17 (4) ◽  
pp. 366-374
Author(s):  
Muralidhar Rajamani ◽  
Chitra Ramamurthy
Keyword(s):  
Intraocular Pressure ◽  
High Risk ◽  
Retrospective Review ◽  
Ultrasound Biomicroscopy ◽  
Scleral Flap ◽  
Modified Technique ◽  
Topical Medication ◽  
Number Of Patients ◽  
The Mean ◽  
Wick Technique

Introduction: Ologen™ is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. Subscleral implantation of Ologen has been described involving fashioning a gutter beneath the scleral flap. This, however, would not prevent fibrosis at the margins of the scleral flap. We describe a modified technique of Ologen® placement that has the potential to prevent scarring at the margins of the flap withoutthe need to fashion a gutter. Materials and methods: The study involved a retrospective review of patients who had undergone trabeculectomy with Ologen implantation by the wick technique between January 2015 and August 2016. Patients judged to be at high risk of trabeculectomy failure were operated with this technique. Results: A total of six patients with median age of 38.5 years were included in the study. The mean preoperative intraocular pressure (IOP) was 30.8 ± 7.3 mmHg, which reduced to 10.6 ± 2.2 mmHg 18 months after surgery. By 18 months postoperative, all patients had IOP in the low teens (two patients required additional topical medication). One patient had two episodes of hypotony that responded to steroids and cycloplegics. Another patient required two needlings to bring IOP under control. No other complications were noted. Ultrasound biomicroscopy done 3 months after surgery showed two pieces of Ologen in one patient. Conclusions: The results of our study show that this technique may be used effectively in patients at high risk of trabeculectomy failure. Further studies in a larger number of patients with diverse high-risk conditions are required before this technique is recommended for general use.

Early Complications of using Dual Mobility Cup in Total Hip Arthroplasty. A Systematic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Khairy Mahmoud ◽  
Saleh Gameel Mansour ◽  
Ibrahim Barsoum Anis
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Early Complication ◽  
Dual Mobility Cup ◽  
Early Complications ◽  
Dual Mobility ◽  
Search Results ◽  
Revision Tha ◽  
Dual Mobility Cups ◽  
Cup Arthroplasty

Abstract Background Total hip arthroplasty (THA) is considered one of the most successful surgical procedures providing pain relief and improvement of function in patients with end-stage hip arthritis that does not respond to non-operative treatments. As health care continues to improve and life expectancy increases, the demand for total joint replacement will grow to reflect this more active, aging population. Objectives This study aims to review early complications of dual mobility cup arthroplasty. The objective is to perform a systematic review of early complications of dual mobility cup arthroplasty for primary and revision cases. Methodology Types of studies we will include randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, and we will exclude case reports, case series studies, cross sectional studies, non English studies. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: THA, Dual mobility cup, complications, intraprosethetic dislocation. Results Early complication rate in dual mobility cups is significantly higher in revision cases compared to primary cases, with the exception of IPD which was significantly lower in revision cases. Early complication rate of conventional THA was significantly higher than both primary and revision dual mobility cups. Conclusion Dual mobility THAs are a good alternative to traditional bearing surfaces with long survivorship and low rates of instability after primary and revision THA. The rate of complications which are unique to the procedure, including intraprosthetic dislocation, is relatively low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to further evaluate the use of dual mobility in primary and revision THA.

Increase in Safe Zone Area of the Acetabular Cup Using Dual Mobility Cups in THA

2017 ◽  
Vol 27 (4) ◽  
pp. 361-367 ◽  
Author(s):  
Takaaki Ohmori ◽  
Tamon Kabata ◽  
Toru Maeda ◽  
Yoshitomo Kajino ◽  
Tadashi Taga ◽  
...  
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
Safe Zone ◽  
Stable Range ◽  
Dual Mobility Cup ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
Computed Tomography Images ◽  
Revision Tha ◽  
Dual Mobility Cups

Background Dual mobility cup (DMC) inserts reduce the risk of dislocation after total hip arthroplasty (THA). No available research has clearly delineated stability advantages of DMC inserts in primary and revision THA. We investigated: (i) the degree of change in the safe zone of the cup when a DMC insert is used compared to a fixed insert; (ii) the method of selecting candidates for a DMC insert without changing the position of the acetabular (cup) component during revision THA in frequent dislocation cases caused by implant impingement. Methods A model of the pelvis and femur was developed from computed tomography images. The safe zone was defined as the area in the acetabular component, over which conditions for stable range of motion were satisfied. The safe zone was calculated for both a fixed and a DMC insert over a predetermined range of 3-D motion, and the effect of increasing the anteversion position of the femoral component from 5° to 35° was quantified. Results The lowest ratio of the area of the safe zone was about 4.9 at 20° anteverison of the femoral component. Safe zone of DMC inserts zone had increased stability of 10°-15° in both vertical and horizontal directions, compared to fixed inserts. A 5- to10-fold expansion of the safe zone can be expected with the use of DMC insert. Conclusions DMC insert could help to set the acetabular component more accurately in primary and revision THA.

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