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Ameztoy Gallego J, Cruz Pardos A, Gomez Luque J, Cuadrado Rubio LE, Fernández Fernández R. Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05816-8. [PMID: 37085676 DOI: 10.1007/s00264-023-05816-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE Instability remains as an unsolved complication after revision total hip arthroplasty (rTHA). Dual mobility (DM) cups have decreased dislocation rate in rTHA; however, there are few clinical studies that evaluate the risk of dislocation after rTHA in patients with high risk of instability. METHODS Between 2007 and 2019, 95 consecutive rTHA using a DM cup, in 93 patients with instability risk factors were retrospectively reviewed. Instability risk factors were defined as follows: deficient abductor mechanism (22.1%), previous dislocation (68.4%), Paprosky 3 acetabular bone defect (21.1%), neuromuscular disease (4.2%), lumbar spine arthrodesis (6.3%), and more than one previous surgery (33.6%). Mean follow-up was 4.3 ± 2.4 years. Clinical and radiographic parameters were reported. DM cup survival was determined using a Kaplan-Meier analysis with re-revision for any cause as the end-point. Surgical complications and re-dislocation rate was recorded. RESULTS Seven DM cups were re-revised; three due to aseptic loosening, three due to peri-prosthetic joint infection (PJI), and one due to instability. At seven years follow-up, the survival rate of the DM cup using re-revision for any reason as the end-point was 82.4% (95% confidence interval, 66.4-98.4%). There were 12 (12.6%) complications: two (2.1%) dislocations, six (6.3%) PJI, four (4.2%) peri-prosthetic fractures. CONCLUSION Our findings suggest DM cups are effective reducing dislocation rate in rTHA in patients with a high risk of instability, without increasing early aseptic loosening and with a low rate of dislocation. Nevertheless, longer follow-up is needed to confirm implant stability and dislocation rates in the long term.
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Affiliation(s)
- Juan Ameztoy Gallego
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain.
| | - Ana Cruz Pardos
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
| | - Javier Gomez Luque
- Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain
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2
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Butler JT, Stegelmann SD, Butler JL, Bullock M, M Miller R. Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review. J Orthop Surg Res 2023; 18:226. [PMID: 36945061 PMCID: PMC10032016 DOI: 10.1186/s13018-023-03724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. METHODS PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) score. RESULTS After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. CONCLUSIONS Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.
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Affiliation(s)
- Justin T Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA.
| | - Samuel D Stegelmann
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Johnathon L Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Matthew Bullock
- Department of Orthopedic Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard M Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
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Donovan RL, Johnson H, Fernando S, Foxall-Smith M, Whitehouse MR, Blom AW, Kunutsor SK. The Incidence and Temporal Trends of Dislocation After the Use of Constrained Acetabular Components and Dual Mobility Implants in Primary Total Hip Replacements: A Systematic Review and Meta-Analysis of Longitudinal Observational Studies. J Arthroplasty 2022; 37:993-1001.e8. [PMID: 35051608 DOI: 10.1016/j.arth.2022.01.017] [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: 10/17/2021] [Revised: 12/20/2021] [Accepted: 01/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation after a primary total hip replacement (pTHR) remains a common cause of treatment failure. Constrained acetabular components (CACs) and dual mobility implants (DMIs) may mitigate this in patients at high risk of dislocation or with significant intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with CACs and DMIs in pTHR. METHODS Longitudinal studies reporting dislocation after the use of CACs or DMIs in pTHR were sought from Medline and Embase to September 2020. Secondary outcomes included revision surgery for dislocation and for all causes. RESULTS A total of 46 studies (3 CAC and 43 DMI) comprising 582 CACs and 18,748 DMIs were included. The pooled incidence of dislocation was 1.08% (95% confidence interval [CI]: 0.00-3.72; range 0.27%-2.60%) over a weighted mean follow-up of 4.1 years for CACs, compared with 0.25% (95% CI: 0.08-0.46; range 0.00%-4.72%) over 6.2 years for DMIs. For DMIs, there was a temporal decline in dislocations from the 1980s onward, and dislocation rates remained low (<1%) until 15 years postoperatively. There were insufficient data for similar analysis of CACs. All studies were at high risk of bias. The incidence of revision for dislocation after CACs was 0.3% vs 0.1% for DMIs, and the incidence of revision for all causes after CACs was 4.8% vs 2.7% for DMIs. CONCLUSION DMIs demonstrated a lower incidence of dislocation compared with CACs; however, there was a relative absence of CACs used in the context of pTHR in the literature. Temporal trends in dislocation have improved over time for DMIs.
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Affiliation(s)
- Richard L Donovan
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Harvey Johnson
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Sherwin Fernando
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Michael Foxall-Smith
- Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; Trauma and Orthopaedic Surgery, North Bristol NHS Trust, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, Unite Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, Unite Kingdom
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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 2021. [DOI: 10.3390/prosthesis3010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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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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Hoggett L, Cross C, Helm A. Acetabular revision using a dual mobility cup as treatment for dislocation in Charnley total hip arthroplasty. Bone Joint J 2020; 102-B:423-425. [PMID: 32228082 DOI: 10.1302/0301-620x.102b4.bjj-2019-1492.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS Dislocation remains a significant complication after total hip arthroplasty (THA), being the third leading indication for revision. We present a series of acetabular revision using a dual mobility cup (DMC) and compare this with our previous series using the posterior lip augmentation device (PLAD). METHODS A retrospective review of patients treated with either a DMC or PLAD for dislocation in patients with a Charnley THA was performed. They were identified using electronic patient records (EPR). EPR data and radiographs were evaluated to determine operating time, length of stay, and the incidence of complications and recurrent dislocation postoperatively. RESULTS A total of 28 patients underwent revision using a DMC for dislocation following Charnley THA between 2013 and 2017. The rate of recurrent dislocation and overall complications were compared with those of a previous series of 54 patients who underwent revision for dislocation using a PLAD, between 2007 and 2013. There was no statistically significant difference in the mean distribution of sex or age between the groups. The mean operating time was 71 mins (45 to 113) for DMCs and 43 mins (21 to 84) for PLADs (p = 0.001). There were no redislocations or revisions in the DMC group at a mean follow-up of 55 months (21 to 76), compared with our previous series of PLAD which had a redislocation rate of 16% (n = 9) and an overall revision rate of 25% (n = 14, p = 0.001) at a mean follow-up of 86 months (45 to 128). CONCLUSION These results indicate that DMC outperforms PLAD as a treatment for dislocation in patients with a Charnley THA. This should therefore be the preferred form of treatment for these patients despite a slightly longer operating time. Work is currently ongoing to review outcomes of DMC over a longer follow-up period. PLAD should be used with caution in this patient group with preference given to acetabular revision to DMC. Cite this article: Bone Joint J 2020;102-B(4):423-425.
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Affiliation(s)
- Lee Hoggett
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Charlotte Cross
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
| | - Anthony Helm
- Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Preston, UK
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Cypres A, Fiquet A, Girardin P, Fitch D, Bauchu P, Bonnard O, Noyer D, Roy C. Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis. J Orthop Surg Res 2019; 14:376. [PMID: 31752951 PMCID: PMC6868773 DOI: 10.1186/s13018-019-1436-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 10/29/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The separate design concepts of dual-mobility cups and triple-taper femoral stems were developed to improve survivorship following total hip replacement (THR) by reducing instability/dislocation and enabling enhanced fixation. Successful outcomes at over two decades have been reported with earlier-generation devices based on these concepts. The current study aimed to provide the first long-term results with a unique pairing of later-generation dual-mobility cup and triple-taper cementless femoral stem after a decade of use in patients undergoing THR. METHODS In this retrospective analysis, records were reviewed for all subjects implanted with this dual-mobility cup/cementless femoral stem combination at three centers between 2002 and 2005. Any subject who had not already had follow-up visit beyond 10 years, was not previously revised, and still living were invited for a single follow-up visit consisting of Merle d'Aubgine Scores, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and standard radiographs. RESULTS There were 244 THRs available for analysis. At a mean follow-up of 11.9 years, the Kaplan-Meier survivorship (endpoint: revision for any reason) was 99.1% (95% CI, 97.6-99.7) for the stem and 95.9% (95% CI, 93.1-97.6) for the cup. Merle d'Aubigne Scores were significantly improved from baseline and WOMAC scores were in the satisfactory range at the final follow-up. Radiographic analysis revealed no cases of stem subsidence, no cases of bone hypertrophy, 1 (0.4%) case of bone atrophy, and 3 (1.2%) cases of osteolysis around the stem. No subjects had radiolucent lines greater than 1 mm in any femoral Gruen zone. Evidence of cup migration was seen in 1 (0.4%) subject and 1 (0.4%) subject had evidence of osteolysis that was seen in Gruen zones I, II, IV, and V. CONCLUSIONS This combination of a later-generation dual-mobility cup and cementless triple-taper stem was associated with excellent survivorship and satisfactory functional outcomes at over 10 years follow-up. TRIAL REGISTRATION ClinicalTrials.gov, NCT02648152. Date of registration: January 6, 2016. Retrospectively registered.
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Affiliation(s)
- Alain Cypres
- Clinique du Renaison, 75 Rue Général Giraud, 42300, Roanne, France.
| | | | | | | | | | | | - Daniel Noyer
- Hôpital de Bourgoin-Jallieu, Bourgoin-Jallieu, France
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Prudhon JL, Caton JH, Aslanian T. Charnley femoral cemented stem with a permeable and resorbable cement restrictor and low-viscosity cement - Clinical and radiographical evaluation of 100 cases at a mean follow-up of 6.55 years. SICOT J 2019; 5:39. [PMID: 31674903 PMCID: PMC6824441 DOI: 10.1051/sicotj/2019034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/27/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In 1979, in his first book dealing with low-friction arthroplasty (LFA), Charnley highlighted the use of a cement restrictor. Breusch and Malchau described in 2005 the "second-generation cementing technique." The main objective of this study was to report on the clinical survival of 100 cases of Charnley femoral component implanted in 2007 and 2008 using a permeable and resorbable cement restrictor and a low-viscosity antibiotic-loaded cement. The secondary objectives were to analyze the complications and side effects and the accuracy of the device positioning. MATERIAL AND METHODS This was a monocentric retrospective review of a prospectively compiled database. Diaphyseal restrictor was biodegradable and permeable to gas, blood, and fluids to avoid intramedullary over pression during cementation. The cement was a low-viscosity antibiotic-loaded cement. Among 3555 patients, we selected the first continuous 100 cases of patients where we implanted the device. Survival probability was computed according to Kaplan-Meier method. RESULTS Mean follow-up was 6.55 ± 2.6 (range 1-11). Considering femoral component revision as the endpoint, survival rate was 100%. No patients died intraoperatively, none in the first month and the first year after surgery. No early periprosthetic fractures have been reported. DISCUSSION As described initially by Charnley, the use of a cement restrictor was highly recommended through the different generations of cementing techniques. Hypotensive episodes and cardiac arrest have been reported during cement insertion. In our series, we did not deplore any adverse effect related to the cementation. CONCLUSION Our study demonstrates a 100% survival rate of a cemented femoral component without adverse effects when using routinely a resorbable and permeable cement restrictor and a low-viscosity cement. Bone cement is still a fantastic ally for the surgeon and the patients.
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Affiliation(s)
| | | | - Thierry Aslanian
- Consultant, 25 chemin jan Baptiste Gillard, 69300 Caluire et cuire, France
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9
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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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10
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Tabori-Jensen S, Hansen TB, Stilling M. Low dislocation rate of Saturne ®/Avantage ® dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg 2019; 139:605-612. [PMID: 30547264 DOI: 10.1007/s00402-018-3093-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dislocation is a serious and common complication and a great concern with the use of total hip arthroplasty (THA) when treating displaced femoral neck fracture (FNF). Dual-mobility (DM) THA might reduce the dislocation risk. We aim to report the dislocation and revision rate of primary DM THA in patients with displaced FNF. MATERIALS AND METHODS Between 2005 and 2015, 966 consecutive patients (676 women) at mean age 80.5 years (range 42-104) with displaced FNF were operated with DM articulation THA by posterolateral approach (PLA). Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death of the patient or August 1st, 2017. Data were crosschecked with the National Patient Registry. Patient's mental state was tested upon admissions. Surgeon's educational level was noted and post-operative cup position was measured. RESULTS At minimum 1.6-year follow-up, there were 45 (4.7%) dislocations and eight (0.8%) cup revisions. The 30-day mortality was 9.2% and 533 patients (55.2%) were dead at the time of last follow-up. We observed eight intraprosthetic dislocations (IPD); six occurred in relation to closed reduction. Cementless stem fixation was associated with higher dislocation risk (p = 0.04) and higher rate of stem complications (p = 0.002). There was no significant association between cognitive impairment and dislocation (OR 2.0, 95% CI 0.96-4.34, p = 0.06). CONCLUSION Overall, DM THA inserted via PLA results in an acceptable dislocation risk and low revision rate in fragile, old patients with acute FNF fracture, regardless of mental status. A unique complication in DM THA is IPD, which requires an immediate open reduction surgery.
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Affiliation(s)
- Steffan Tabori-Jensen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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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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12
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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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Zoccali C, Attala D, Scotto di Uccio A, Rossi B, Scotto G, Biagini R. The dual mobility cup in muscular skeletal oncology: rationale and indications. INTERNATIONAL ORTHOPAEDICS 2017; 41:447-453. [PMID: 28138720 DOI: 10.1007/s00264-017-3407-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/13/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Because of the improvement of medical therapy and the corresponding increase in life expectancy, orthopaedic surgeons are obliged to perform more wide resections rather than intramedullary stabilization nailing for patients affected by tumours of the hip compared to the past. Wide resection often causes joint instability, so prosthetic reconstruction presents a higher risk of dislocation than in primary osteoarthritis cases. The aim of the present paper is to classify the indications for the dual mobility cup (DMC) hip prosthesis based on the anatomic structures involved in the disease and to analyse the rationale to reduce the risk of dislocation. METHODS Indications were analyzed and classified based on all the cases in which the DMC prosthesis was used for reconstruction after hip resection in an oncological research hospital. RESULTS Four classes of indications were identified; for classes I and IV the indication for DMC prosthesis can be considered strong; for classes II and III the indications must be evaluated considering the specific case, based on life expectancy, performance status, presence of osteoarthritis, and availability of adjuvant local therapies. When the DMC prosthesis is indicated, the cup should always be cemented, either alone or with augmentation techniques, to decrease the risk of mobilization due to local disease progression. CONCLUSIONS DMC can be a valid alternative in reconstruction of the hip after tumor removal; nevertheless, prospective, randomized studies are necessary to verify the real dislocation rate based on the entity of resection.
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Affiliation(s)
- Carmine Zoccali
- Oncological Orthopedics Department, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Dario Attala
- Oncological Orthopedics Department, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy
| | | | - Barbara Rossi
- Oncological Orthopedics Department, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy
| | - Gennaro Scotto
- Oncological Orthopaedics Department, Galeazzi Orthopedic Research Institute, Via Galeazzi 4, Milan, Italy
| | - Roberto Biagini
- Oncological Orthopedics Department, IFO - Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy
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