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

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

Hip International ◽

10.1177/1120700019873617 ◽

2019 ◽

pp. 112070001987361 ◽

Cited By ~ 3

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.

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

Hip International ◽

10.1177/1120700019889031 ◽

2019 ◽

pp. 112070001988903 ◽

Cited By ~ 3

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.

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Preliminary Results of Total Hip Arthroplasty in Subjects at Risk for Dislocation Using a Novel Modular Cementless Dual-Mobility Cup. A Single-Center Prospective Study

Prosthesis ◽

10.3390/prosthesis3010006 ◽

2021 ◽

Vol 3 (1) ◽

pp. 53-60

Author(s):

Giuseppe Solarino ◽

Filippo Simone ◽

Antonello Panella ◽

Arianna Carlet ◽

Flavia Riefoli ◽

...

Keyword(s):

At Risk ◽

Total Hip Arthroplasty ◽

Prospective Study ◽

Hip Arthroplasty ◽

Mean Value ◽

Harris Hip Score ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip

Nowadays total hip arthroplasty (THA) is widely considered the operation of the century in orthopedic and traumatological fields. Despite this fact, instability and dislocation after THA are a common reason for revision surgery. The purpose of this prospective study is to evaluate the preliminary clinical and radiological results of a novel dual mobility cup. We evaluated 32 consecutive cases of patients who underwent THA using a novel dual mobility cup—with holes in the cup, a modular metallic inlay and a crosslinked polyethylene. All of them were considered at risk of instability of the implant due to primary or concomitant diagnosis. The preoperative Harris hip score was 54.7 on average. At a minimum 2 years follow-up, the mean HHS raised up to a mean value of 88.4; this improvement was statistically significant (p < 0.0001). None of the patients enrolled in this study sustained a postoperative dislocation at a mean follow-up of 39.6 months. Furthermore, no patients sustained modular liner dissociation or an intraprosthetic dislocation. As such, survivorship free from dislocation was 100% at both 2 and 5 years. This study demonstrates that the modular dual mobility (DM) socket provides dual articulation, larger jump distance, and greater range of motion before impingement, which significantly reduce the rate of dislocation.

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Dual-Mobility Cup Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Retrospective Study With a Median Follow-Up of 5 Years

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211013244 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110132

Author(s):

Zhenfa Zhang ◽

Guixing Xu ◽

Lei Cao ◽

Wei Sun ◽

Xianshang Zeng ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Complication Rate ◽

Femoral Neck Fractures ◽

Harris Hip Score ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Total Hip

Introduction: Patient outcomes following modern dual-mobility cup total hip arthroplasty (DM-THA) remains a concern. Few reports have focused on the use of modern DM-THA in the setting of Asian populations for displaced osteoporotic femoral neck fractures (FNFs). This study aimed to investigate the outcomes of Chinese population with displaced osteoporotic FNFs initially treated with modern DM-THA. Materials and Methods: Data from 112 consecutive patients (112 hips) with displaced osteoporotic FNFs initially treated with modern DM-THA during 2011-2018 were retrospectively analyzed. Follow-ups were performed at 3 months, 6 months, 12 months, and then every 1 year after surgery. The primary endpoint was the Harris Hip Score (HHS); the secondary endpoint was the main orthopedic complication rate. Results: The mean HHS improved from 58.62 (±15.79) prior to surgery to 86.13 (±9.92) at the final follow-up. The main complication rate was 14.2% (16/112). Sixteen complications in 10 patients were recorded. Of the 16 complications, there were 2 (1.7%) cases requiring revision DM-THA, 3 (2.6%) cases of loosening, 2 (1.7%) cases of migration, 3 (2.6%) intra-prosthetic dislocation (IPD), 4 (3.5%) cases of tilting, and 2 (1.7%) cases of severe wear. The need for revision was attributed to prosthesis loosening associated with poor bony quality. Conclusion: In patients with displaced osteoporotic FNFs, DM-THA may yield favorable functional outcomes and a low rate of main orthopedic complications, in particular, a low dislocation rate.

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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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