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Hidayat T, Ismail R, Tauviqirrahman M, Saputra E, Ammarullah MI, Lamura MDP, Bayuseno AP, Jamari. Running-in behavior of dual-mobility cup during the gait cycle: A finite element analysis. Proc Inst Mech Eng H 2024; 238:99-111. [PMID: 38156402 DOI: 10.1177/09544119231216023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
The running-in process is considered an essential aspect of the comprehensive wear process. The phenomenon of running-in occurs during the initial stages of wear in the prosthetic hip joint. Within the field of tribology, the running-in phenomenon of the hip joint pertains to the mechanism by which the contact surfaces of the artificial hip joint components are adjusted and a suitable lubricating film is formed. During the process of hip joint running-in, there is an interaction between the metal surface of the ball and the joint cup, which results in adjustments being made until a steady state is achieved. The achievement of desirable wear existence and reliable performance of artificial hip joint components are reliant upon the tribological running-in of the hip joint. Despite the establishment of current modeling approaches, there remains a significant lack of understanding concerning running-in wear, particularly the metal-on-polyethylene (MoP) articulations in dual-mobility cups (DMC). An essential aspect to consider is the running-in phase of the dual mobility component. The present study employed finite element analysis to investigate the running-in behavior of dual mobility cups, wherein femoral head components were matched with polyethylene liners of varying thicknesses. The analysis of the running-in phase was conducted during the normal gait cycle. The results of this investigation may be utilized to design a dual-mobility prosthetic hip joint that exhibits minimal running-in wear.
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Affiliation(s)
- Taufiq Hidayat
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Department of Mechanical Engineering, Universitas Muria Kudus, Kudus, Central Java, Indonesia
| | - Rifky Ismail
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Center for Biomechanics Biomaterials Biomechatronics and Biosignal Processing (CBIOM3S) Diponegoro University, Semarang, Central Java, Indonesia
| | - Mohammad Tauviqirrahman
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
| | - Eko Saputra
- Department of Mechanical Engineering, Semarang State Polytechnic, Semarang, Central Java, Indonesia
| | - Muhammad Imam Ammarullah
- Biomechanics and Biomedics Engineering Research Centre, Universitas Pasundan, Bandung, West Java, Indonesia
| | - M Danny Pratama Lamura
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang, Central Java, Indonesia
| | | | - Jamari
- Department of Mechanical Engineering, Diponegoro University, Semarang, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang, Central Java, Indonesia
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Haider H, Weisenburger J, Siskey R, Deans C, Hartman C, Kildow B, Konigsberg B, Garvin K. Do articular surfaces of dual mobility hips have more wear and friction? An in vitro investigation. J Arthroplasty 2023:S0883-5403(23)00390-X. [PMID: 37105329 DOI: 10.1016/j.arth.2023.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Larger head-to-neck ratio of dual mobility (DM) hip arthroplasties provide greater range of motion/less risk of dislocation, but raise concerns for high wear and friction. We measured in vitro, the wear rates of contemporary DM hips with highly-crosslinked Ultra High Molecular Weight Polyethylene (UHWMPE), where it came from, and their frictional torques. METHODS Hip simulators were used to compare the wear of DM to fixed-bearing (FB) designs of two different implants. Each of eight different configurations underwent millions of simulated walking cycle tests, some as full DM, some as FB controls, some DM with the outer-articulation deliberately immobilized, and some the inner. Wear and three-dimensional-frictional torques were measured and friction independent of size was deduced. RESULTS The DM hips produced lower wear and friction-torque than the FB hips. The DM Wear during walking gait comes mostly from the smaller inner articular surface. If the outer surface was immobilized, the wear and torque of the inner alone would be small, but the full DM (inner and outer free-to-move) wear and torque were smallest of all. Friction measurements expectedly showed larger hips having higher frictional torques, but the DM showed the lowest, again because its motion was mostly the smaller inner articulation; smaller than even a modern fixed-bearing hip. CONCLUSION The DM hips appear to combine the benefits of greater range of motion and less impingement of larger hips, with the lower wear and friction of smaller FB hips, with some benefits compromised if the outer or inner articulations are immobilized.
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Affiliation(s)
- Hani Haider
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Joel Weisenburger
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Ryan Siskey
- Exponent: Engineering and Scientific Consulting, 3440 Market Street, Philadelphia, PA, 19104
| | - Christopher Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Curtis Hartman
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Beau Konigsberg
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, 68198
| | - Kevin Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE, 68198
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Foissey C, Batailler C, Rajput V, Premkumar AB, Servien E, Lustig S. No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up. SICOT J 2023; 9:1. [PMID: 36648274 PMCID: PMC9878999 DOI: 10.1051/sicotj/2022050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France,Corresponding author:
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France
| | - Vishal Rajput
- The Midyorkshire Hospitals NHS Trust WF14DG Wakefield United Kingdom
| | | | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 69100 Lyon France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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Assi C, Mansour J, Boulos K, Caton J, Samaha C, El-Kayyem E, Yammine K. Major acetabular defects: outcomes of first revision total hip arthroplasty using Kerboull cross-plate with allograft and cemented dual mobility cup at a maximum follow-up of fourteen years. INTERNATIONAL ORTHOPAEDICS 2022; 46:2539-2546. [PMID: 36038654 DOI: 10.1007/s00264-022-05556-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The use of dual mobility cups (DMC) has been shown to reduce hip instability after revision surgery. For severe acetabular bone loss, reconstruction with a Kerboull cross-plate and bone allograft would contribute to restoring native hip position and bone stock. Only two papers reported on the combination of Kerboull cross-plate with bone allograft and cemented DMC in revision total hip arthroplasty (THA). METHODS This is a monocentric retrospective study (28 cases) of first-time revision THA using such a construct in American Association of Orthopaedic Surgeons (AAOS) grade III and IV acetabular bone defect. Detailed demographic, clinical and radiographic results were recorded and evaluated. RESULTS With a mean follow-up of six ± 3.63 years, no case of instability was reported. The modified Harris Hip Score (mHHS) was 88.4 ± 10.1. No hook fracture or mechanical failure was observed. Non-progressive radiolucent lines were recorded. Osteointegration of the allografts was observed in all cases with a mean Grodet score of 7.9 ± 0.97. CONCLUSIONS In first revision THA, the use of a Kerboull cross-plate with allograft and a cemented DMC in AAOS grade III and IV acetabular bone defects demonstrated excellent clinical and radiological outcomes with no recorded cases of dislocation or mechanical failure.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
- Center of Evidence-Based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Karl Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | | | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Elie El-Kayyem
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon.
- Institut de Chirurgie Orthopédique, Lyon, France.
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Yang J, Bryan AJ, Drabchuk R, Tetreault MW, Calkins TE, Della Valle CJ. Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation. Hip Int 2022; 32:648-655. [PMID: 33566709 DOI: 10.1177/1120700020988469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. METHODS A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). RESULTS There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%). DISCUSSION Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew J Bryan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Monobloc Dual Mobility With a Minimum 5-Year Follow-Up: A Safe and Effective Solution in Primary Total Hip Arthroplasty. J Arthroplasty 2022; 37:83-88. [PMID: 34593287 DOI: 10.1016/j.arth.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Instability constitutes over 20% of revisions after total hip arthroplasty (THA). Dual mobility (DM) designs were introduced as a solution to this problem. However, the few publications that have reported promising results for monobloc DM constructs have been limited by sample size or length of follow-up. The purpose of this study is to evaluate mid-term outcomes (minimum 5-year follow-up) of a single-surgeon series utilizing a monobloc DM acetabular component in patients with high risk for dislocation. METHODS This is a single-surgeon consecutive series of 207 primary THAs implanted with a monobloc DM component in patients who were considered at high risk for dislocation. Patient demographics and case-specific data were collected retrospectively. All patients had a minimum of 5-year follow-up. The Mann-Whitney U test was used to assess continuous variables, whereas categorical variables were analyzed using the chi-square test. Survival probability was calculated using the Kaplan-Meier method. RESULTS Radiographic analysis did not reveal acetabular radiolucency in any patients, and there were no revisions for aseptic loosening. In addition, there were no dislocations. Seven of 205 patients (3.4%) were revised, 5 on the femoral side due to periprosthetic fracture and the remaining two for infection. Survivorship of the acetabular component from revision was 99%. The mean Veteran RAND (VR-12) physical score improved from 7 (standard deviation [SD]: 13.7) preoperatively to 9.5 (SD: 17.6) at the final follow-up. Similarly, the hip disability osteoarthritis score improved from 8 (SD: 17.9) preoperatively to 21.2 (SD: 37). CONCLUSION Monobloc DM components reliably prevent dislocation after primary THA in high-risk patients. At mid-term follow-up, this DM monobloc component demonstrates excellent implant survivorship, radiographic fixation, and improved functional outcomes.
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Kunze KN, Premkumar A, Bovonratwet P, Sculco PK. Acetabular Component and Liner Selection for the Prevention of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2021; 9:01874474-202112000-00004. [PMID: 34910697 DOI: 10.2106/jbjs.rvw.21.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty. » Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time. » The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options. » Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners). » Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Pai FY, Ma HH, Chou TFA, Huang TW, Huang KC, Tsai SW, Chen CF, Chen WM. Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:541. [PMID: 34126990 PMCID: PMC8204435 DOI: 10.1186/s12891-021-04404-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome. Methods We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that were conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of the most common failure modes and patient reported outcomes were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome. The study design of each study was assessed for potential bias and flaws by using the quality assessment tool for case series studies. Results A total of 119 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively. Level of evidence of this meta-analysis was IV. Conclusion Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA. Future research directions should focus on, (1) long-term outcome of modern dual-mobility design, including specific concerns such as intra-prosthetic dislocation and elevated metal ion, and (2) cost-effectiveness analysis of dual-mobility implant as an alternative to conventional THA for patients who are at high risk of dislocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04404-4.
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Affiliation(s)
- Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsan-Wen Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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Giacomo P, Giulia B, Valerio P, Vincenzo S, Pierluigi A. Dual mobility for total hip arthroplasty revision surgery: A systematic review and metanalysis. SICOT J 2021; 7:18. [PMID: 33749588 PMCID: PMC7984151 DOI: 10.1051/sicotj/2021015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties. METHODS A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery. RESULTS Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection. DISCUSSION A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant's Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA.
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Affiliation(s)
- Placella Giacomo
- Hospital San Raffaele - Orthopaedic Department, Milan 20132, Italy
| | | | - Pace Valerio
- Università degli Studi di Perugia, Perugia 06123, Italy
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Assi C, Barakat H, Mansour J, Samaha C, Yammine K. Primary total hip arthroplasty: mid-term outcomes of dual-mobility cups in patients at high risk of dislocation. Hip Int 2021; 31:174-180. [PMID: 31875722 DOI: 10.1177/1120700019889031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Hanane Barakat
- Department of Anesthesiology, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon.,Center of Evidence-based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon
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Dubin J, Huang RC, Muskat A, Sharpe K, Malkani AL, Mont M, Westrich G. Five-Year Follow-Up of Clinical Outcomes with an Anatomic Dual-Mobility Acetabular System: A Multicenter Study. Arthroplast Today 2020; 6:543-547. [PMID: 32760774 PMCID: PMC7393448 DOI: 10.1016/j.artd.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 01/19/2023] Open
Abstract
Background The dual-mobility implant system has been shown to increase impingement-free range of motion and decrease dislocation risk by increasing the effective head size. In addition, the anatomic dual-mobility (ADM) cup offers relief between the acetabular shell rim and the iliopsoas tendon. This study was designed to review a series of hips implanted with the ADM acetabular cup to examine clinical outcomes after 5 years of implantation at multiple orthopaedic centers. Methods We retrospectively queried our prospectively collected total joint arthroplasty registry for patients who underwent total hip arthroplasty with an ADM cup from January 2008 to December 2012 at 4 different orthopaedic institutions and who had minimum 5-year follow-up. Harris Hip Scores and visual analog scale scores were evaluated. Postoperative complications, dislocations, and revisions for any reason were recorded. Results A total of 142 patients had a mean follow-up of 5.7 years (range: 5.0 to 8.0 years). Radiographic analysis showed no radiolucent lines, osteolysis, or acetabular loosening. There were no dislocations in this patient series. Two (1.2%) hips required a revision because of adverse local tissue reactions related to corrosion from a recalled modular neck stem, but this was unrelated to the ADM cup. The mean Harris Hip pain scores increased from 17 points preoperatively to 39 points at the most recent follow-up (P < .001). The mean Harris Hip function score increased from an average of 29 points preoperatively to 38 points at the most recent follow-up (P < .001). The mean visual analog scale score showed patient improvement from 6.5 preoperatively to 1.2 postoperatively (P < .001). Conclusions ADM prostheses were designed to reduce the risk of dislocation by increasing the size of the effective femoral head. In this multicenter study of ADM cups used in primary total hip arthroplasty, we demonstrated good clinical and radiographic outcomes, no dislocations, and no revisions at midterm 5-year minimum follow-up. Patient-reported outcome measures were also improved, supporting the use of this implant.
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Affiliation(s)
- Jeremy Dubin
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
| | - Ronald C. Huang
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
- BronxCare Health Systems, Department of Orthopedic Surgery, Bronx, NY, USA
| | - Ahava Muskat
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
| | | | | | - Michael Mont
- Cleveland Clinic, Department of Orthopedics, Cleveland, Ohio, USA
- Lenox Hill at Northwell, New York, NY, USA
| | - Geoffrey Westrich
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY, USA
- Corresponding author. Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division, 535 East 70th Street, New York, NY 10021, USA. Tel.: +1 212 606-1510.
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12
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Heckmann N, Weitzman DS, Jaffri H, Berry DJ, Springer BD, Lieberman JR. Trends in the use of dual mobility bearings in hip arthroplasty. Bone Joint J 2020; 102-B:27-32. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1669.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aims Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. Methods All primary and revision THA procedures reported to AJRR from 2012 to 2018 were analyzed. Patients of all ages were included and subdivided into DM and traditional bearing surface cohorts. Patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Associations were determined by chi-squared analysis and logistic regression was performed to assess outcome variables. Results A total of 406,900 primary and 34,745 revision THAs were identified, of which 35,455 (8.7%) and 8,031 (23.1%) received DM implants respectively. For primary THA, DM usage increased from 6.7% in 2012 to 12.0% in 2018. Among revision THA, DM use increased from 19.5% in 2012 to 30.6% in 2018. Patients < 50 years of age had the highest rates of DM implantation in every year examined. For each year of increase in age, there was a 0.4% decrease in the rate of DM utilization (odds ratio (OR) 0.996 (95% confidence interval (CI) 0.995 to 0.997); p < 0.001). Females were more likely to receive a DM implant compared to males (OR 1.077 (95% CI 1.054 to 1.100); p < 0.001). Major teaching institutions and smaller hospitals were associated with higher rates of utilization. DM articulations were used more commonly for dysplasia compared with osteoarthritis (OR 2.448 (95% CI 2.032 to 2.949); p < 0.001) during primary THA and for instability (OR 3.130 (95% CI 2.751 to 3.562) vs poly-wear; p < 0.001) in the revision setting. Conclusion DM articulations showed a marked increase in utilization during the period examined. Younger patient age, female sex, and hospital characteristics such as teaching status, smaller size, and geographical location were associated with increased utilization. DM articulations were used more frequently for primary THA in patients with dysplasia and for revision THA in patients being treated for instability. Cite this article: Bone Joint J 2020;102-B(7 Supple B):27–32.
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Affiliation(s)
- Nathanael Heckmann
- Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Dena S. Weitzman
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Daniel J. Berry
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
| | | | - J. R. Lieberman
- Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, California, USA
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13
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Jonker RC, van Beers LWAH, van der Wal BCH, Vogely HC, Parratte S, Castelein RM, Poolman RW. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2020; 106:509-517. [PMID: 32278733 DOI: 10.1016/j.otsr.2019.12.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. METHODS We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. RESULTS The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25). CONCLUSION This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. LEVEL OF EVIDENCE III, systematic review of level III studies.
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Affiliation(s)
- Ragna C Jonker
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands
| | - Bart C H van der Wal
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sebastien Parratte
- Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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14
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Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual Mobility Cups in Revision Total Hip Arthroplasty: Efficient Strategy to Decrease Dislocation Risk. J Arthroplasty 2020; 35:500-507. [PMID: 31563399 DOI: 10.1016/j.arth.2019.08.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is a challenging surgery with a higher rate of complications than primary arthroplasty, particularly instability and aseptic loosening. The purpose of this study is to compare dual mobility cup (DMC) and standard mobility cup (SMC) in all rTHAs performed at our institution over a decade with a 1 year minimum follow-up. METHODS Two hundred ninety-five rTHAs (acetabular only and bipolar revisions) between 2006 and 2016 were retrospectively reviewed. These were divided into those with a DMC (184 revisions) or SMC (111 revisions). Dislocation and complications requiring re-revision were reported. RESULTS The rTHA mean age was 69 years ± 13.9 (19-92) and the mean follow-up was 2.3 years. Dislocation risk was statistically lower (P = .01) with a DMC (3.8%; 7/184) than with an SMC (13.5%; 15/111). DMC required re-rTHA in 24/184 (13%) for any reason compared to SMC in 19/111 (17.1%) (P = .34). There was no significant difference in early aseptic loosening (P = .28) between the 2 groups. For young patients (≤55 years), results were similar with a lower dislocation rate in the DMC group (P = .24) and no increased risk of early aseptic loosening (P = .49). CONCLUSION This study demonstrates that for all rTHA indications DMC compared to SMC has a significantly decreased risk of postoperative dislocation without risk of early aseptic loosening at medium term follow-up. The use of DMC in rTHA is an important consideration particularly with the predicted increased incidence of both primary and revision THA globally.
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Affiliation(s)
- Axel Schmidt
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
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15
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Iorio R, Iannotti F, Mazza D, Speranza A, Massafra C, Guzzini M, D'Arrigo C, Ferretti A. Is dual cup mobility better than hemiarthroplasty in patients with dementia and femoral neck fracture? A randomized controlled trial. SICOT J 2019; 5:38. [PMID: 31674902 PMCID: PMC6824440 DOI: 10.1051/sicotj/2019035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/27/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Treatment of patients with dementia and hip fracture is challenging. Total hip arthroplasty (THA) with dual mobility cup (DMC) has been designed to reduce the rate of dislocation by increasing the stability of the implant. This study aimed to compare the dislocation rates of DMC THA with hemiarthroplasty (HA) in elderly patients with displaced femoral neck fracture (FNF) and a diagnosis of dementia. METHODS All patients with a displaced FNF and dementia diagnosis were prospectively randomized to hemiarthroplasty or THA with DMC treatment during a 2-year period. Finally, the outcomes of 30 patients in the HA group were compared with those of 30 patients in the DMC THA group. Dislocation rate at a minimum follow-up of 1 year was evaluated as the primary outcome. Reoperation rate, time to surgery, surgical time, length of hospital stay, and 30-day and 1-year mortality were also evaluated. RESULTS There was a significant difference regarding rates of dislocation in favor of THA with DMC and with regard to length of surgery (p = 0.04) in favor of bipolar HA. Dislocation occurred in five patients (16.6%) treated with bipolar HA and no one (0%) in patients treated with THA with DMC (p = 0.019). There was no difference with regard to the 30-day mortality, 1-year mortality, reoperations, and length of hospital stay between the two groups of patients. DISCUSSION THA with DMC seems to be a safe and reliable choice to reduce the rate of dislocation at 1 year in patients with dementia and FNF without a higher risk of mortality.
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Affiliation(s)
- Raffaele Iorio
- Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy
| | | | - Daniele Mazza
- Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy
| | | | - Carlo Massafra
- Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy
| | - Matteo Guzzini
- Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy
| | | | - Andrea Ferretti
- Sapienza University, Sant'Andrea Hospital, Rome 00189, Italy
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16
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Brazier BG, Wren ER, Blackmer MJ, Marino DV, Cochran JM. Catastrophic failure of a dual mobility bearing in a revision total hip arthroplasty. Arthroplast Today 2018; 4:275-278. [PMID: 30186904 PMCID: PMC6123245 DOI: 10.1016/j.artd.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 10/29/2022] Open
Abstract
The following case demonstrates an example of a catastrophic failure of a dual mobility (DM) bearing used in the setting of a revision total hip arthroplasty for an acetabular component with an excessive abduction angle. Currently, in the literature, it has been demonstrated that DM bearings have decreased polyethylene wear at abduction angles up to 65°; however, this has only been shown in in vitro studies. To our knowledge, there have been no reports of in vivo DM bearings that have demonstrated these same results. In this case, a DM bearing was used in a revision surgery with a retained acetabular component that had an abduction angle of approximately 70°-75° which ultimately led to catastrophic polyethylene failure.
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Affiliation(s)
- Brett G Brazier
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Ethan R Wren
- Department of Orthopedic Surgery, Michigan State University, East Lansing, MI, USA
| | - Michael J Blackmer
- Department of Orthopedic Surgery, Michigan State University, East Lansing, MI, USA
| | - Dominic V Marino
- Department of Orthopedic Surgery, Michigan State University, East Lansing, MI, USA
| | - Jason M Cochran
- Department of Orthopedic Surgery, McLaren Greater Lansing Hospital, Sparrow Hospital, Michigan State University, East Lansing, MI, USA
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17
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Romagnoli M, Grassi A, Costa GG, Lazaro LE, Lo Presti M, Zaffagnini S. The efficacy of dual-mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and meta-analysis of comparative studies. INTERNATIONAL ORTHOPAEDICS 2018; 43:1071-1082. [PMID: 30032356 DOI: 10.1007/s00264-018-4062-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Although long-term reports of total hip arthroplasty (THA) showed successful results, instability remains a major complication. Recently, dual-mobility cups (DMC) have gained more and more interest among clinicians, with encouraging results in terms of lower rate of dislocation associated with good clinical results, but a lack of evidence exists regarding the real efficacy of this implant design compared to traditional fixed-bearing total hip arthroplasties. METHODS A systematic search was performed in PubMed, Google scholar, Cochrane Library, and EMBASE by two independent reviewers for comparative studies available till December 2017, with the primary objective to demonstrate a real lower dislocation rate of DMC implants compared to unipolar fixed-bearing cup designs. A meta-analysis was conducted with the collected pooled data about dislocation rate, calculating the risk difference (RD) and relative risk (RR) with 95% CI for dichotomous variables. Heterogeneity was tested using the χ2 and Higgins' I2 tests. A fixed-effect model was used because the statistical heterogeneity was below 50%. RESULTS After performing a critical exclusion process, the number of eligible studies included for final synthesis considered was 15, describing the results of a total of 2408 total hip arthroplasties (50.6% with a dual-mobility acetabular cup design, 49.4% with a standard fixed-bearing design). The fixed-effect meta-analysis showed a slight significant risk ratio of 0.16 (95% CI, 0.09, 0.28; I2 = 0%, p < 0.00001); a statistically significant difference in favor of the DMC group was maintained also considering only primary or revision arthroplasties, traumatic fractures or elective patients with diagnosis of osteoarthritis, avascular osteonecrosis or rheumatic arthritis. CONCLUSIONS With the intrinsic limitations of our study design and based on the current available data, this study demonstrates that dual-mobility acetabular components decrease the risk of post-operative instability also in high-risk patients, both in primary and revision hip arthroplasties. However, new high-quality studies, possibly with a randomized control design, should be undertaken in order to strengthen the present data. STUDY DESIGN Level of Evidence III, therapeutic study.
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Affiliation(s)
- Matteo Romagnoli
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCSS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Alberto Grassi
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCSS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Gianluca Costa
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCSS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Lionel E Lazaro
- Hospital for Special Surgery and New York Presbyterian Hospital, 535 East 70th Street, New York, NY, 10021, USA
| | - Mirco Lo Presti
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCSS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic and Biomechanics Laboratory, IRCSS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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18
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Hollar KA, Ferguson DS, Everingham JB, Helms JL, Warburton KJ, Lujan TJ. Quantifying wear depth in hip prostheses using a 3D optical scanner. WEAR : AN INTERNATIONAL JOURNAL ON THE SCIENCE AND TECHNOLOGY OF FRICTION LUBRICATION AND WEAR 2018; 394-395:195-202. [PMID: 30220743 PMCID: PMC6136671 DOI: 10.1016/j.wear.2017.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The visualization of wear depth in hip prostheses can assist the evaluation of new bearing materials and implant designs. The goal of this study was to develop an accurate, fast, and economical methodology to generate colorimetric maps of wear depth in hip implants using a structured light 3D optical scanning system. The accuracy and precision of this novel technique were determined using reference blocks with known wear depths. This technique was then used to measure the in vitro wear of a hip resurfacing device for canines that incorporates a highly cross-linked polyethylene liner. The 3D optical scanner had an average accuracy of 2.1 µm and an average precision of 1.4 µm, which corresponded to errors less than 10% when measuring wear depths of 20 µm or greater. The scanner was able to repeatedly generate 3D colorimetric maps of wear depth in highly cross-linked polyethylene liners in 20 min or less. These colorimetric maps identified localized regions with 3-fold greater wear than the average wear depth, and revealed liners with asymmetric wear patterns. For the first time, this study has validated the use of 3D optical scanning to quantify in vitro surface wear in a hip replacement device.
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Affiliation(s)
- Katherine A. Hollar
- Boise State University, 1910 University Drive, Boise, ID 83725-2085, United States
| | - Daniel S. Ferguson
- Global Inspection Solutions, LLC, 6635 North Baltimore Avenue, Portland, OR 97203, United States
| | - John B. Everingham
- Boise State University, 1910 University Drive, Boise, ID 83725-2085, United States
| | - Jillian L. Helms
- Boise State University, 1910 University Drive, Boise, ID 83725-2085, United States
| | - Kevin J. Warburton
- Boise State University, 1910 University Drive, Boise, ID 83725-2085, United States
| | - Trevor J. Lujan
- Boise State University, 1910 University Drive, Boise, ID 83725-2085, United States
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19
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Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series. INTERNATIONAL ORTHOPAEDICS 2017; 42:761-767. [PMID: 28986663 DOI: 10.1007/s00264-017-3660-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/24/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the incidence of dislocation and specific complications of the dual-mobility cup. METHODS The arthroplasties involved 167 hips in 165 patients; 51 hips (30.5%) were in men and 116 (69.4%) were in women. The active articulation E1® dual-mobility cup (Biomet, Warsaw, IN, USA) was used, and the surgical approach was posterolateral in 120 hips and anterolateral in 47 hips. RESULTS Four (2.3%) dislocations were observed. Mean time of dislocation was 30.5 days post-operatively. Three incomplete reductions occurred during closed reduction. When comparing parameters between dislocation and no-dislocation groups, there were no differences in patient and surgical parameters. However, all dislocations occurred in patients with femoral neck fractures and in the posterolateral approach group. CONCLUSION The incidence of dislocation in total hip arthroplasty (THA) using a dual-mobility cup was acceptable, and cup diameter of the dislocation group was substantially larger than that of no-dislocation group. Based on clinical outcomes of our study, we conclude that the dual-mobility cup is a reliable option in THA, and further studies are necessary.
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20
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Kasparek MF, Renner L, Faschingbauer M, Waldstein W, Rueckl K, Boettner F. Salvage of a monoblock metal-on-metal cup using a dual mobility liner: a two-year MRI follow-up study. INTERNATIONAL ORTHOPAEDICS 2017; 42:1035-1041. [PMID: 28929204 DOI: 10.1007/s00264-017-3641-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Revision of failed modular metal-on-metal total hip replacement (MoM-THA) can be technically difficult. A dual mobility liner can help to salvage a well-fixed acetabular component. The present paper reports the clinical and radiographic outcome of revision of failed Birmingham modular MoM-THA using a dual mobility liner. METHODS The present study reports on ten patients (3 female and 7 male) with 11 revision THAs. Patients underwent revision an average of 51 months (range 40-73 months) after index procedure. Mean follow-up after the revision was 31 months (range 24-37 months) and all patients underwent an MRI with metal artifact reduction software (MARS) at least two years after revision to assess for local polyethylene wear and osteolysis. RESULTS The Harris Hip score improved from 92.2 (range 63.0-100.0) to 100.0 (p = 0.072). One patient had a one-time dislocation within seven days of surgery. No patient required additional surgeries. Radiographs showed no signs of component loosening and osteolysis and MRI imaging revealed no evidence of polyethylene wear or osteolysis. CONCLUSION A dual mobility liner in an existing Birmingham cup can provide excellent clinical and radiological short-term results without MRI evidence of increased polyethylene wear. Post-operative hip precautions should be enforced.
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Affiliation(s)
- Maximilian F Kasparek
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Renner
- Orthopaedic Department, Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Faschingbauer
- Department of Orthopedic Surgery, University Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian Rueckl
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction & Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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21
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Boyer B, Neri T, Geringer J, Di Iorio A, Philippot R, Farizon F. Long-term wear of dual mobility total hip replacement cups: explant study. INTERNATIONAL ORTHOPAEDICS 2017; 42:41-47. [PMID: 28577036 DOI: 10.1007/s00264-017-3525-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/21/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Dual mobility THA implantations are increasing. THA survival of more than 15 years is considered long-term survival based on the Charnley prosthesis, which has a median wear rate of 39 to 98 mm3/year. What is the median wear rate of dual mobility THA cups and its repartition on the liner volume? What are the factors influencing dual mobility wear? METHODS Thirty-five explants were analysed. The liners were entirely mapped with a fully automatic stripe light scanner that uses green LED light. RESULTS The liners had a median wear rate of 38 mm3/year. The distribution of the wear between the two bearings varied greatly. No factor was found influencing wear volumes. CONCLUSIONS The median annual wear of dual mobility liners is at least as low as the wear of cemented polyethylene liners and lower than equivalent cementless liners. The two articulations of the dual mobility THA do not cause more wear. LEVEL OF EVIDENCE Level IV - case series.
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Affiliation(s)
- Bertrand Boyer
- Mines de Saint-Etienne, Unité SAINBIOSE, INSERM U1059, Université de Lyon-St Etienne, Lyon, France.
- Laboratoire de Physiologie de l'Exercice, Centre d'Orthopédie Traumatologie CHU St Etienne, Université Jean Monnet, 42055, St Etienne Cedex 2, France.
| | - Thomas Neri
- Laboratoire de Physiologie de l'Exercice, Centre d'Orthopédie Traumatologie CHU St Etienne, Université Jean Monnet, 42055, St Etienne Cedex 2, France
| | - Jean Geringer
- Mines de Saint-Etienne, Unité SAINBIOSE, INSERM U1059, Université de Lyon-St Etienne, Lyon, France
| | - Alexandre Di Iorio
- Laboratoire de Physiologie de l'Exercice, Centre d'Orthopédie Traumatologie CHU St Etienne, Université Jean Monnet, 42055, St Etienne Cedex 2, France
| | - Remi Philippot
- Laboratoire de Physiologie de l'Exercice, Centre d'Orthopédie Traumatologie CHU St Etienne, Université Jean Monnet, 42055, St Etienne Cedex 2, France
| | - Frederic Farizon
- Laboratoire de Physiologie de l'Exercice, Centre d'Orthopédie Traumatologie CHU St Etienne, Université Jean Monnet, 42055, St Etienne Cedex 2, France
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22
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Caton JH, Ferreira A. Dual-mobility cup: a new French revolution. INTERNATIONAL ORTHOPAEDICS 2017; 41:433-437. [PMID: 28197702 DOI: 10.1007/s00264-017-3420-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 01/16/2023]
Affiliation(s)
| | - André Ferreira
- Clinique du Parc, 155 Ter Boulevard de Stalingrad, 69006, Lyon, France.
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