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

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.

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The Dislocating Hip Replacement – Revision with a Dual Mobility Cup in 56 Consecutive Patients

The Open Orthopaedics Journal ◽

10.2174/1874325001408010268 ◽

2014 ◽

Vol 8 (1) ◽

pp. 268-271 ◽

Cited By ~ 21

Author(s):

Thomas Jakobsen ◽

Andreas Kappel ◽

Flemming Hansen ◽

Niels Krarup

Keyword(s):

Median Number ◽

Harris Hip Score ◽

Consecutive Series ◽

Dual Mobility Cup ◽

Dual Mobility ◽

Hip Replacements ◽

The Mean ◽

Difficult Challenge ◽

One Year

Introduction: Recurrent dislocations of hip replacements are a difficult challenge. One treatment option for recurrent dislocations is the use of a dual mobility cup. The aim of this study was to retrospective investigate the effect of dual mobility cups as a treatment for recurrent dislocations in a consecutive series. Materials and Methods: 56 consecutive patients were revised in the period November 2000 to December 2010. The mean age at revision was 72 years (SD 11, range 37-92)) and median number of dislocations before revision surgery were 4 (IQR, 2-11). In all cases, revision was made with a Saturne dual mobility cup (Amplitude, Neyron, France). The mean follow-up period was 44 months (SD 30, range 0.1-119). Results: One patient (1.8%) experienced a re-dislocation. Three patients (5.3%) had to be revised. One due to disintegration between the femoral head and inner shell, one due to loosening of the acetabular component, and one due to infection. Harris Hip Score improved from a mean of 76 before index surgery to 87 within one year after index surgery. Conclusion: This study advocates the use of a dual mobility cup for treatment of recurrent dislocations of THR. However, studies with a longer follow up are needed in order to evaluate implant survival.

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A systematic review of short metaphyseal loading cementless stems in hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1199.r1 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 502-511 ◽

Cited By ~ 10

Author(s):

S. Lidder ◽

D. J. Epstein ◽

G. Scott

Keyword(s):

Systematic Review ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Ethical Practice ◽

Term Survival ◽

The Mean ◽

Review Reports ◽

Femoral Implants ◽

Hip Arthroplasties

Aims Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. Results A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. Conclusion Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502–511.

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

Hip International ◽

10.1177/1120700018757788 ◽

2018 ◽

Vol 28 (5) ◽

pp. 491-497 ◽

Cited By ~ 7

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.

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Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

10.21203/rs.3.rs-422921/v1 ◽

2021 ◽

Author(s):

FIRAT OZAN ◽

Murat Kahraman ◽

Ali Baktır ◽

Kürşat Gençer

Keyword(s):

Revision Arthroplasty ◽

Femoral Stem ◽

Harris Hip Score ◽

Catastrophic Failure ◽

Total Hip ◽

Catastrophic Failures ◽

Revision Tha ◽

The Mean ◽

Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

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Cable plating with a single strut allograft in the treatment of periprosthetic fractures of the femur

Hip International ◽

10.1177/1120700018761519 ◽

2018 ◽

Vol 29 (1) ◽

pp. 58-64 ◽

Cited By ~ 2

Author(s):

Jonathan R Manara ◽

John A Mathews ◽

Harvey S Sandhu

Keyword(s):

Plate Fixation ◽

Periprosthetic Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Reproducible Method ◽

The Mean ◽

Modified Harris Hip Score ◽

Unified Classification System ◽

Hip Arthroplasties

Background: Hip arthroplasties are increasing worldwide resulting in an increasing number of periprosthetic fractures. These fractures are difficult to treat with various the different fixation or revision options described, many of which have high complication rates. Purpose: To investigate whether our described method of treating periprosthetic fractures is an effective, safe and reproducible method of treating patients. Methods: We describe the largest series of a cable plate fixation system combined with a single cortical strut allograft to treat patients with periprosthetic fractures of the hip (Unified Classification System B1 and selected B2, C and D). Results: Between July 2006 and March 2015, 28 patients were treated using this method. The mean follow-up was 2.2 years (3 months to 9 years). The mean Oxford Hip Score (OHS) at final follow-up was 32 and the mean modified Harris Hip Score (mHHS) 67. There were 3 complications including 1 failure that required revision surgery, 1 case of infection successfully treated with debridement, antibiotics and retention, and a case of discomfort from the metalwork which we managed conservatively. Conclusion: This method of anatomical restoration of the femur with dual-plane fixation is a highly effective method of treating this complex group of patients, and should be considered as a first line of treatment. It shows that there is a role for successful treatment with internal fixation of certain B2, C and D fractures with this technique.

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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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Hip arthroscopy-assisted reduction and fixation for femoral head fracture dislocations: Clinical and radiographic short-term results of seven cases

Journal of Orthopaedic Surgery ◽

10.1177/2309499019881865 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901988186 ◽

Cited By ~ 2

Author(s):

Shan-Ling Hsu ◽

Chung-Yang Chen ◽

Jih-Yang Ko ◽

Chi-Hsiang Hsu ◽

Hao-Chen Liu ◽

...

Keyword(s):

Femoral Head ◽

Arthroscopic Surgery ◽

Fracture Dislocation ◽

Harris Hip Score ◽

Consecutive Series ◽

Femoral Head Fracture ◽

Articular Fractures ◽

Fracture Dislocations ◽

The Mean

Purpose: Femoral head fracture dislocations are serious articular fractures that are associated with soft tissue injuries and are challenging to treat. Arthroscopic surgery may be a way to treat fracture reduction and fixation, thereby avoiding the need for extensive arthrotomy. Methods: We followed up a consecutive series of seven patients with femoral head fracture dislocation via a scope-assisted percutaneous headless screw fixation between 2016 and 2017. The clinical and radiological results were assessed. Results: The locations of the fracture were all involving infra-foveal area. The mean follow-up duration was 18 (range 12–24) months. The mean Harris hip score was 90.8 (range 88–93) at the latest follow-up. None of the patients showed early osteoarthritis, heterotopic ossification, or avascular necrosis. The average maximal displacement of the fracture site was improved from preoperative 6.79 mm (range 4.21–12.32) to postoperative 2.76 mm (range 0.97–3.97). Concomitant intra-articular hip lesions secondary to traumatic hip dislocation can also be treated. Conclusion: Managing the infra-foveal fracture of the femoral head using arthroscopic reduction and fixation with headless screws can be a safe and minimally invasive option. More patients and longer follow-up are needed for a definite conclusion.

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Primary Total hip Arthroplasty Using A Short Bone-Conserving Stem in Young Adult Osteoporotic Patients with Dorr type C Femoral Bone

10.21203/rs.3.rs-41955/v1 ◽

2020 ◽

Author(s):

Ping Zhen ◽

Yanfeng Chang ◽

Heng Yue ◽

Hui Chen ◽

Shenghu Zhou ◽

...

Keyword(s):

Young Adult ◽

Hip Arthroplasty ◽

Harris Hip Score ◽

Femoral Canal ◽

Femoral Bone ◽

Severe Osteoporosis ◽

Type C ◽

The Mean ◽

Hip Arthroplasties

Abstract Background: Dorr Type C femoral bone exhibits a wide, stovepipe-shaped femoral canal and thin cortices in the proximal femur. Dorr C bone combined with severe osteoporosis is an important challenge in primary hip arthroplasty. In this study, we assessed the effects of short metaphyseal fitting cementless stems on preformatted primary total hip arthroplasties in young adult osteoporotic patients with this femoral presentation.Methods: A total of 42 hip arthroplasties were performed in 35 young patients (range, 20 to 36 years) using a short Tri-lock bone preservation metaphyseal-fitting cementless femoral component between 2012 and 2017. The mean age at surgery of the 27 male (33 hips) and 8 female (9 hips) patients was 27.5 ± 3.7 years (range 20.3 to 35.8 years). The mean body mass index (BMI) was 20.2 kg/m2 (range, 16.8–23.2 kg/m2). According to Dorr’s criteria, all 42 femora were classified as type C bone and all femurs suffered from severe osteoporosis (Singh index≤3). Results: The mean follow-up period was 5.5 ± 1.1 years (range, 3.0–8.0 years). The clinical and functional results improved for the Harris hip score, WOMAC, and UCLA activity scores. The Harris Hip score improved from 48.0 ± 8.0 (range 38.0 to 61.0) preoperatively to 87.0 ± 9.0 (range 77.0 to 92.0) at 12 months after surgery and 91.0 ± 8.0 (range 85.0 to 98.0) at final follow-up. The preoperative UCLA activity score was 3.0±0.5 points (range, 1.0–4.0 points), which significantly improved to 7.5±0.7 points (range, 6.0–8.0 points) at the final follow-up. No patient exhibited thigh pain at the final follow-up. The mean stem-to-canal fill percentages were 97% ± 2.1% (anteroposterior view at midstem). For stem alignment, 40 hips (95.2%) of the femoral stem were positioned neutral to 3° of varus with reference to the femoral shaft axis. The remaining two were positioned at 4° varus to 4° valgus. Radiographic evaluation showed good osteointegration of the implants in follow-up.Conclusions: Based on the tapered-wedge design and proximal porous coating, the shortened tapered conventional stem can achieve reliable stability through neck filling and metaphyseal fixation, which does not depend on the isthmus hoop stress. This stem was suitable in severe osteoporotic patients with Type C bones in young adults who presented with a correspondingly straightened femoral canal with a wide isthmus and thin cortex.

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Higher UHMWPE wear-rate in cementless compared with cemented cups with the Saturne® Dual-Mobility acetabular system

Hip International ◽

10.1177/1120700018768615 ◽

2018 ◽

Vol 28 (2) ◽

pp. 125-132 ◽

Cited By ~ 3

Author(s):

Steffan Tabori-Jensen ◽

Christina Frølich ◽

Torben B. Hansen ◽

Søren Bøvling ◽

Morten Homilius ◽

...

Keyword(s):

Wear Rate ◽

Polyethylene Wear ◽

Walking Distance ◽

Harris Hip Score ◽

Evaluation Activity ◽

Dual Mobility ◽

Time Of Surgery ◽

Activity Measurements ◽

The Mean

Introduction: Dual mobility (DM) total hip arthroplasty (THA) may reduce dislocation risk, but might increase the risk of high polyethylene (PE) wear due to double wearing surfaces. Methods: 127 patients (97 female) with 129 hips operated with THA after displaced femoral neck fracture FNF between 2005 and 2011, were seen for a cross-sectional clinical follow-up. Acetabular components were Saturne® DM cups with 28mm chrome-cobalt heads in UHMWPE. Cementless cups (n = 73) were hydroxyapatite coated. Radiographs were obtained for analysis of cup placement, 2D polyethylene wear and wear-rate (PolyWare 3D), and further radiological evaluation. Activity measurements included Timed Up and Go test (TUG) and walking distance from Harris Hip Score (HHS). Results: At a mean follow-up of 2.83 (1.0-7.7) years the mean wear was 0.82 mm (range 0.17-4.51, SD 0.50), and the wear-rate was 0.37 mm (range 0.06-1.90, SD 0.29). Wear-rate of 0.43 mm/year (SD 0.30) in cementless cups was higher (p = 0.004) than 0.30 mm/year (SD 0.27) in cemented cups. Mean age at time of surgery was 75.1 years (range 30-95). There was no correlation between age at time of surgery and wear (p = 0.56). There was no correlation between cup inclination and wear-rate (p = 0.35). TUG was mean 13.4 seconds (range 4.5-30.1) and correlated with wear rate (p = 0.03). Conclusions: At short term follow-up, the mean wear-rate in old and low demand patients was high, correlated to activity, and was above the generally accepted osteolysis threshold (0.1 mm/yr.). Cementless HA-coated cups had higher wear-rate than cemented cups.

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