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Falgiano PA, Rowland RJ, Heifner JJ, Corces A. Dual-mobility with modular components for primary total hip arthroplasty in bilateral bony ankylosis of the hips: A case report. Int J Surg Case Rep 2024; 122:110161. [PMID: 39159594 PMCID: PMC11382324 DOI: 10.1016/j.ijscr.2024.110161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary total hip arthroplasty (THA) is a procedure performed in the United States for a variety of indications, with operation rates slated to increase over 275 % by 2040 when compared to 2014 (Thilak et al., 2015). Dual-mobility (DM) implants have gained popularity in the United States since gaining approval in the early 2010s (Heckmann et al., 2020). It has been well reported that DM implants decrease the risk of dislocation after primary and revision THA (Vielpeau et al., 2011; Donovan et al., 2022; Heifner et al., 2023; Foissey et al., 2023; Schmidt et al., 2020; Neri et al., 2019). CASE PRESENTATION We present the case of a 33-year-old male with a suspected ankylosing spondylitis (AS) diagnosis and bilateral bony ankylosis of the hips who underwent staged THA with modular dual-mobility (MDM) implants. At one year post-operatively, the patient is walking without the use of an assistive device and reports a VAS pain score of 0 at rest and 2 with activity and HHS of 90. CLINICAL DISCUSSION Implant selection is important in this patient population due to the increased risk of dislocation. Contemporary reports reveal MDM implants have demonstrated a substantial reduction in dislocation risk compared to fixed-bearing implants in patients with a high risk of dislocation. We opted to place the acetabular component inside the safe zone to improve stability and use the dual-mobility prosthesis to achieve our desired range of motion. CONCLUSION The improved stability of DM implants allows for a greater range of acetabular positions in patients who have a highly unpredictable functional outcome at the time of surgery. Our preliminary results contribute to the growing list of indications for MDM total hip arthroplasty.
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Affiliation(s)
| | - Robert J Rowland
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
| | | | - Arturo Corces
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
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van Dooren B, Peters RM, Visser D, van Steenbergen LN, Bos PK, Zijlstra WP. Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup. Arthroplast Today 2024; 25:101281. [PMID: 38292143 PMCID: PMC10826135 DOI: 10.1016/j.artd.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.
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Affiliation(s)
- Bart van Dooren
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Orthopedic surgery, Martini Hospital, Groningen, The Netherlands
| | - David Visser
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - P Koen Bos
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Heifner JJ, Keller LM, Fox YM, Sakalian PA, Corces A. The Performance of Primary Dual-Mobility Total Hip Arthroplasty in Patients Aged 55 Years and Younger: A Systematic Review. Arthroplast Today 2023; 24:101241. [PMID: 38023650 PMCID: PMC10661692 DOI: 10.1016/j.artd.2023.101241] [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: 08/23/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Dual-mobility (DM) total hip arthroplasty (THA) combines the stabilization advantage provided by large head articulation with the low friction advantage provided by small head articulation. There is momentum for DM to be used in a wider selection of patients, with some advocating for DM to be the routine primary total hip construct. Further investigation is needed to determine whether the use of DM in younger adults is validated by aggregate data. Our objective was to review the literature for the clinical performance of DM THA in patients aged 55 years and younger. Methods A systematic review of the literature was performed according to the guidelines of Preferred Reporting in Systematic Reviews and Meta-Analyses. Inclusion in the review required clinical outcome reporting for DM primary THA in ambulatory patients aged 55 years or younger. The risk of bias was appraised using the Cochrane risk of bias in nonrandomized studies of interventions and the quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework. Results Across a sample of 1048 cases, the frequency weighted term of follow-up was 87.7 months. The pooled rate of revision was 9.5%. The Harris Hip Score significantly improved from 49.1 preoperatively to 93 postoperatively. The Postel-Merle d'Aubigné score significantly improved from 10.5 preoperatively to 17.1 postoperatively. Conclusions The literature demonstrates satisfactory short-term outcomes with a mitigated risk of dislocation for DM used as primary THA in patients aged 55 years and younger. The current findings suggest that third-generation designs provide reduced rates of intraprosthetic dislocation and improved survivorship.
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Affiliation(s)
| | - Leah M. Keller
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Yitzak M. Fox
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
| | - Philip A. Sakalian
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
| | - Arturo Corces
- Department of Orthopaedic Surgery, Larkin Hospital, Coral Gables, FL, USA
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Moghnie A, Tigani D, Consoli A, Castiello E, Ganci M, Amendola L. Modular dual mobility articulation in primary and revision hip arthroplasty: lights and shadows. J Orthop Surg Res 2023; 18:278. [PMID: 37020227 PMCID: PMC10074885 DOI: 10.1186/s13018-023-03730-8] [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: 12/10/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE The use of dual mobility cups in total hip arthroplasty has gained popularity in light of the fact it enables to reduce dislocation through increased jumping distance (JD) and impingement-free arc of movement. Modular Dual Mobility Cup (modular DMC) systems have been recently introduced to enable the use of dual mobility cups with standard metal-backed shells. The objective of this study was twofold: calculate the JD for each modular DMC system and conduct a systematic literature review to report clinical outcomes and reasons for failure of this construct. METHODS The JD was calculated using the Sariali formula: JD = 2Rsin [(π/2 - Ψ - arcsin (offset/R))/2]. A qualitative systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search for English and French articles between January 2000 and July 2020 was run on PubMed, EMBASE, Google Scholar, and Scopus with the primary objective of finding articles about modular DMC systems. RESULTS We identified eight 8 different manufacturers of modular DMC systems and 327 publications on the subject. After screening for duplicates and eligibility, we identified 229 publications: 206 articles were excluded because they contained no reports on modular DMC systems, whereas other three were not included because they focused on biomechanical aspects. Among the 11 included articles, 2 were prospective case series, 9 were retrospective case series. True dislocation occurred in 25 cases (0.9%), and six of them were solved by closed reduction without necessity of revision, while all 5 intraprosthetic dislocations were operated. CONCLUSIONS Modular DMCs are a valid method to deal with complex THA instability, with good clinical and patient-reported outcomes, low complication rates, and low revision rates at early follow-up. We would advise cautious optimism on the role of modular DMC implants, as it seems safer to use ceramic instead of metallic heads whenever possible to avoid the increase cobalt and chromium trace ion serum levels.
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Affiliation(s)
- Alessandro Moghnie
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy.
| | - Domenico Tigani
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Alberto Consoli
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Emanuela Castiello
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Marco Ganci
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Luca Amendola
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
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Bellova P, Goronzy J, Riedel R, Grothe T, Hartmann A, Günther KP. Dual-Mobility Cups in Primary Total Hip Arthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:74-84. [PMID: 34500491 DOI: 10.1055/a-1527-7758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Dual-mobility cups (DMCs) were introduced in France more than 40 years ago and are increasingly used not only in hip revision but also primary hip arthroplasty. Due to a simulated large-head articulation and increased jumping distance, DMCs can contribute to a high range of motion in the hip joint and reduce the risk of instability. Numerous studies have reported low dislocation rates and high survival rates in the mid-term follow-up. Nevertheless, long-term data, especially on primary hip replacement, remain limited, and the effect of recent designs and material innovations is still unclear. Therefore, primary DMCs are mainly proposed in patients at high risk for dislocation (i.e. pelvitrochanteric insufficiency, compromised spinopelvic mobility, neuromuscular disorders, obesity and femoral neck fractures). Based on a review of recently published studies referring to these indications, the current study discusses the advantages and disadvantages of DMCs.
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Affiliation(s)
- Petri Bellova
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Jens Goronzy
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Roman Riedel
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Tim Grothe
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Albrecht Hartmann
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Klaus-Peter Günther
- Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
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Tigani D, Castiello E, Moghnie A, Bruschi A, Serra M, Amendola L, Bordini B. Use of dual-mobility cup in primary total hip arthroplasties: an Italian regional register (RIPO) study on three thousand, seven hundred and ten cases. INTERNATIONAL ORTHOPAEDICS 2023; 47:99-106. [PMID: 36449052 PMCID: PMC9810563 DOI: 10.1007/s00264-022-05639-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The purpose of the study was to investigate the outcome of dual-mobility cup (DM) compared with a standard cup (SC) in primary total hip arthroplasty (THA) in the long-term follow-up based on a regional Italian joint registry (RIPO). METHODS The Registry of Prosthetic Orthopaedic Implant (RIPO) was consulted, looking for all primary THAs implanted from 2000 to 2019. Three thousand seven hundred ten were dual-mobility cup (DM) total hip arthroplasties (THA) and 85.816 were standard cup (SC) THAs, on a total of 89.526 primary THA. Demographics, survival rates and causes of revision were evaluated and compared between the two groups. RESULTS The use of DM progressively increased from 0.4% in 2000 to 7.5% in 2018 of all primary THAs. Revision rate was 3.5% (128 on 3710) for DMC and 4.7% (4061 on 85,816) for SC. DM presented lower dislocation rate if compared to SC with 22-28-mm femoral head diameter. However, DM showed a higher risk of revision for any causes than SC with 32-mm femoral head diameter in long-term follow-up. Nevertheless, no significant difference was measured in terms of demographics and surgical approach for dislocation rate. CONCLUSIONS The DM cup represents a valid implant solution and has a lower dislocation rate than 22-28-mm SC. A slight increase in the use of DM implants over time was observed in the RIPO. However, a larger population and a longer follow-up are needed to further monitor the survival rate of new-generation DM implants.
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Affiliation(s)
- Domenico Tigani
- Department of Orthopaedic Surgery, Ospedale Maggiore "Carlo Alberto Pizzardi", Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Emanuela Castiello
- Department of Orthopaedic Surgery, Ospedale Maggiore "Carlo Alberto Pizzardi", Largo Nigrisoli 2, 40133, Bologna, Italy.
| | - Alessandro Moghnie
- Department of Orthopaedic Surgery, Ospedale Maggiore "Carlo Alberto Pizzardi", Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Alessandro Bruschi
- Department of Biomedical and Neuromotor Science-DIBINEM, IRCCS Rizzoli Orthopaedic Institute, University of Bologna, Via Zamboni 33, 40125, Bologna, Italy.
| | - Margherita Serra
- Department of Biomedical and Neuromotor Science-DIBINEM, IRCCS Rizzoli Orthopaedic Institute, University of Bologna, Via Zamboni 33, 40125, Bologna, Italy
| | - Luca Amendola
- Department of Orthopaedic Surgery, Ospedale Maggiore "Carlo Alberto Pizzardi", Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Via Di Barbiano 1/10, 40136, Bologna, Italy
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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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Wegrzyn J, Longaray J, Baez R, Herrera L. Which femoral neck for a dual mobility cup? A biomechanical evaluation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1783-1793. [PMID: 35570206 PMCID: PMC9349148 DOI: 10.1007/s00264-022-05415-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to evaluate polyethylene (PE) damage and wear lesions to the chamfer of mobile components under mobile and fixed femoral neck impingement at the third articulation, and to determine which femoral neck characteristics should be considered with a dual mobility cup to limit those lesions.
Methods
Two femoral neck geometries (cylindrical and quadrangular) with two surface finishing roughness (rough and polished), and two head-to-neck ratios (28- and 22.2-mm diameter femoral heads) were evaluated in a hip simulator testing. For each characteristic, six femoral necks were tested with six dual mobility cups under fixed and mobile femoral neck impingement conditions. Chamfer PE damage and volumetric wear were evaluated and compared for each femoral neck characteristic and impingement condition.
Results
Under mobile impingement condition, femoral neck characteristics did not significantly affect PE damage and wear lesions to the chamfer (p = 0.283 to 0.810). However, under fixed impingement condition, significantly higher PE damage and wear lesions to the chamfer were produced by the quadrangular geometry compared to the cylindrical geometry (p = 0.004 to 0.025). In addition, with the quadrangular geometry, rough surface finishing was demonstrated to increase volumetric wear of the chamfer (p = 0.009). No significant influence of head-to-neck ratio was observed on PE damage and wear lesions to the chamfer (p = 0.244 to 0.714).
Discussion
This biomechanical study emphasized that femoral neck characteristics are critical with dual mobility cup and tend to favor a cylindrical geometry particularly whether fixed impingement at the third articulation occurs.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre Decker, 4, CH - 1011, Lausanne, Switzerland.
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Vicenti G, Solarino G, Carrozzo M, Simone F, Ottaviani G, Bizzoca D, Zavattini G, Zaccari D, Buono C, Moretti B. Is the Posterior Approach With Posterior locking compression plate and Anterior Allograft Useful and Safe in the Treatment of Periprosthetic Humeral Fractures Following Reverse Total Shoulder Arthroplasty? Geriatr Orthop Surg Rehabil 2022; 13:21514593221080961. [PMID: 35433099 PMCID: PMC9006377 DOI: 10.1177/21514593221080961] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction As the reverse total shoulder arthroplasty (RTSA) surgery has dramatically increased in the last few decades, many complications have followed through. The periprosthetic fracture, at the moment, is still a subject of debate in the orthopedic world. In this monocentric study, along with a literature review of periprosthetic humeral fractures, we would present our institutional experience with the treatment of periprosthetic humeral fractures with a posterior humeral approach, posterior cortex plate fixation, anterior strut allograft, screws, and cerclage wires. Materials and Methods Our study consisted in a prospective monocentric study based on 18 patients, with a mean age of 75.3 years (range 64–88), all following a reverse shoulder total arthroplasty (RTSA). Postoperative follow-ups were taken at 1, 6, and 12 months with objective measurement of shoulder motion and strength, while clinical outcome measures were assessed using the American Shoulder and Elbow Surgeons (ASES score) and visual analog scale (VAS) for pain. Together with that, we performed a literature review focused on the management of periprosthetic humeral fractures after shoulder arthroplasty. Results All fractures consolidated without complication at a mean 4.2 months (range 3–6). At final follow-up, the average active shoulder flexion was 88° (range 62–129°), active abduction 73° (range 52–91°) and active external rotation 22° (range 3–56°). The average ASES score was 73 (range 59–97), while average VAS score was 1.1 (range 0–3). Discussion Surgical treatment of periprosthetic humeral fractures following a shoulder arthroplasty remains a hard challenge for every surgeon, and their treatment must consider fracture’s location, displacement, and local bone quality. Conclusions The posterior approach with a posterior plate placement and anterior strut allograft, which is appliable only in case of a B or C type fracture according to Worland classification, could be a good treatment option for periprosthetic humeral fractures.
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Affiliation(s)
- Giovanni Vicenti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giuseppe Solarino
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Massimiliano Carrozzo
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Filippo Simone
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Guglielmo Ottaviani
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Davide Bizzoca
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Giacomo Zavattini
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Domenico Zaccari
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Claudio Buono
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
| | - Biagio Moretti
- Department of Neuroscience and Organs of Sense, Orthopaedics Section, Faculty of Medicine and Surgery, University of Bari, Bari, Italy
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Moon NH, Do MU, Kim JS, Seo JS, Shin WC. The usefulness of dual mobility cups in primary total hip arthroplasty patients at a risk of dislocation. Sci Rep 2022; 12:774. [PMID: 35031667 PMCID: PMC8760308 DOI: 10.1038/s41598-022-04774-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to evaluate the early results of primary total hip arthroplasty (THA) using dual mobility (DM) cups in patients at a risk of dislocation and compare them with that of fixed bearing (FB) THA. This retrospective study included patients who had undergone primary THA between January 2016 and December 2018 and were at a risk of dislocation. A propensity score-matched analysis was conducted for 63 THA procedures with vitamin-E infused highly cross-linked polyethylene (VEPE) DM bearing and 63 THA procedures performed with FB from the same manufacturer for a mean follow-up period of 3.1 and 3.5 years, respectively. The radiologic outcomes at the last follow-up and incidence of postoperative complications were evaluated and compared statistically between the two groups. The modified Harris hip score (mHHS) was used to assess patient-reported outcomes. Postoperative dislocation occurred in 4 cases (6.3%) in the FB group, but did not occur in the DM group (p = 0.042). There was no difference in the radiologic outcomes and postoperative complications between the two groups. The mHHS at the last follow-up showed satisfactory outcomes in both the groups (DM group, 90.5; FB group, 88.1), without a statistical difference between the groups. The early results of THA using VEPE DM bearing showed better outcomes than that of THA with FB for patients at a risk of dislocation. A longer follow-up period is recommended to assess the stability and overall outcomes.
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Affiliation(s)
- Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea
| | - Min Uk Do
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Jung Shin Kim
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Jae Seung Seo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Republic of Korea.
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Rodríguez Pérez D, Agulló Ferre JL, Del Carmen Rodríguez M, Tramunt Monsonet C. Late Breakage of a Dual-Mobility Polyethylene Insert in a Revision Total Hip Arthroplasty: An Unusual Failure Mode. Arthroplast Today 2021; 12:7-11. [PMID: 34746346 PMCID: PMC8551416 DOI: 10.1016/j.artd.2021.07.013] [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: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
The use of dual-mobility cups has gained popularity in recent years. Thus, surgeons can expect an increase in known and new causes of failure. We report a previously undescribed form of a late intraprosthetic dislocation consisting of a complete breakage of a polyethylene mobile bearing that suffered a dislocation 3 months after its implantation. Two years later, he began feeling anterior groin pain and suffered gait changes. Computed tomography scan revealed an eccentric alignment of the mobile polyethylene bearing suggestive of poly wear. During the revision surgery, the polyethylene was found to be split in 2. Possible causes of this complication are proposed. Our case shows a previously unreported implant-specific complication, so surgeons can identify it.
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12
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Agarwala S, Katariya A, Vijayvargiya M, Shetty V, Swami PM. Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: a prospective cohort study. SICOT J 2021; 7:42. [PMID: 34402791 PMCID: PMC8370015 DOI: 10.1051/sicotj/2021041] [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: 05/05/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Total Hip Replacement (THR) in displaced Fracture Neck of Femur (FNOF) is associated with higher dislocation rates. Conventional THR with a large femoral head and anterior approach has reduced the instability, but it remains higher than THR done for other aetiology. Recent studies have shown reduced dislocation rates with dual mobility THR (DMTHR) for FNOF; however, there is a lack of comparative research to show its superiority over conventional THR. Further, its role in the Asian subcontinent, where the patient requires sitting cross-legged or squatting, has not been studied. Methods: A prospective cohort study of 103 elderly patients with displaced FNOF with a minimum follow-up of 1-year. Fifty-two patients were operated on with DMTHR and fifty-one patients with conventional THR. Both the groups were matched in terms of demographic data, surgical approach, and postoperative protocol. Radiological and functional outcomes in terms of Harris Hip Score (HHS), Range of motion, Patient Reported Outcome Measures (PROM), and Dislocation rate were compared between the two groups. Results: Mean HHS of the DMTHR group was 76.37 at three months and 87.02 at the end of the 1-year postoperatively, which was significantly better than the conventional THR group 65.65 at three months and 72.96 at 1-year. The range of motion was significantly better in the DMTHR group than the conventional THR group. There was no significant difference in radiological outcomes and postoperative dislocation rate between the two groups. Conclusion: Dual mobility implants give better results than conventional implants for primary THA in elderly patients of displaced FNOF regarding better function and greater range of motion.
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Affiliation(s)
- Sanjay Agarwala
- Chief of Surgery and Director Professional Services, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Ameya Katariya
- Resident doctor, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Mayank Vijayvargiya
- Junior Consultant, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Vivek Shetty
- Consultant, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
| | - Pravin Manohar Swami
- Resident doctor, Department of Orthopedics, P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400016, India
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13
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Lee GC, Kamath A, Courtney PM. Clinical Concerns With Dual Mobility- Should I Avoid it When Possible? J Arthroplasty 2021; 36:S88-S91. [PMID: 33549418 DOI: 10.1016/j.arth.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
The utilization of dual mobility (DM) articulations in total hip arthroplasty (THA) is increasing. The principal appeal of DM implants is its ability to reduce postoperative instability by maximizing the effective ball head size for each reconstruction. However, while DM implants have been used worldwide for over 3 decades, the experience in North America is more limited. Moreover, there remains concerns with intraprosthetic dissociation, wear, metallosis, and soft tissue impingement. Therefore, the purpose of this article is to review the available evidence for these potential issues. First, intraprosthetic dissociation (IPD) is a unique complication of DM implants. Although the rate has decreased with improvements in materials and design, the reported prevalence is approximately 1%. Second, wear in DM implants can be unpredictable and increased wear has been reported in younger, active patients. Third, corrosion in modular DM implants has been described and elevations in serum cobalt and chromium levels have been reported. While the clinical significance of these elevations is unclear, it remains a source of concern with these implants. Finally, psoas impingement and entrapment can be a source of persistent groin pain after THA. DM articulations are a valuable addition to the armamentarium of total hip surgeons. However, these bearings are not free of complications. Consequently, current data only support selective use of DM bearings in patients at increased risk for postoperative instability after arthroplasty.
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Atul Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - P Maxwell Courtney
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA
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14
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Jinnai Y, Homma Y, Baba T, Zhuang X, Kaneko K, Ishijima M. Use of Dual Mobility Acetabular Component and Anterior Approach in Patients With Displaced Femoral Neck Fracture. J Arthroplasty 2021; 36:2530-2535. [PMID: 33744082 DOI: 10.1016/j.arth.2021.02.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the antidislocation effect of total hip arthroplasty (THA) via the direct anterior approach (DAA) with dual mobility cup (DMC) for displaced femoral neck fracture (FNF) has already been reported, the clinical result of DMC-DAA-THA for displaced FNF in terms of mortality, complications, and walking ability are still unclear. METHODS 106 cases with DMC-DAA-THA for displaced FNF were investigated of dislocation; perioperative complications; 3-, 6-, and12-month mortality rate; and pre/early postoperative walking ability. The walking ability was stratified into the following four categories: (1) use of a wheelchair (no walking), (2) walking alongside a support (including walkers designed for the elderly), (3) walking using one stick, and (4) unaided walking. RESULTS There was no dislocation withing one-year postoperative. The 3-, 6-, and 12-month mortality rate was 2.8%, 4.7%, and 5.7%. Total complications occurred in 14 cases (14.7%). Although there was no revision surgery, two cases (1.9%) of intraoperative fracture treated without additional fixation, and one case of postoperative fracture was occurred. Among patients with preinjury walking category 2, 3, and 4 (total 94 cases), the number of patients who recovered same walking category at two-week postoperation was 56 cases (59.6%). CONCLUSIONS Our study demonstrated that DMC-DAA-THA for displaced FNF offered quick recovery of walking ability with no dislocation and low one-year mortality rate. We believe that the combination of early postoperative recovery due to the minimal invasiveness of the DAA and decreased dislocation rate due to increased range of motion by DMC and adequate soft tissue tension by DAA contributed to null dislocation.
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Affiliation(s)
- Yuta Jinnai
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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15
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Castiello E, Moghnie A, Tigani D, Affatato S. Dual mobility cup in hip arthroplasty: an in-depth analysis of joint registries. Artif Organs 2021; 46:804-812. [PMID: 34153137 DOI: 10.1111/aor.14015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
Although total hip arthroplasty (THA) has shown successful results, instability remains a major complication. In recent years, dual mobility cups (DMC) have gained interest among clinicians thanks to its low rate of dislocation and good clinical results. The main aim of this work was to describe the accuracy of data on DMC from national and regional joint registries (JRs) and the available worldwide literature. We identified topics on DMC among JRs to propose a new harmonized and standardized section for DMC with the aim to understand its surveillance over the time. We extracted survival and implant data for a separate analysis. After performing a critical exclusion process, nine joint registries were considered eligible and included for final synthesis; these were the results from the available worldwide data from Joints Registries (JRs). In our study, eight analysed JRs reported a slight increase in DMC use in the last decade. In all the JRs evaluated and the available articles, dislocation remains one of the main reasons for revision and re-revision in hip arthroplasties. DMC is considered a valid construct increasingly used worldwide in primary and revision THA with the primary aim of reducing dislocation rates. Annual reports from JRs collect heterogeneous and low-quality information about outcomes and surveillance of DMC, creating a burden for clinicians to extract comparable data from different JR. Longer follow-up and a systematic registering of DMCs with international registry harmonization are needed to monitor DMC outcomes.
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Affiliation(s)
| | | | - Domenico Tigani
- Department of Orthopaedic Surgery, Ospedale Maggiore, Bologna, Italy
| | - Saverio Affatato
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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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: 15] [Impact Index Per Article: 5.0] [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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17
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Zhang Z, Xu G, Cao L, Sun W, Zeng X, Xiong N, Wang S, Yu W, Liu Q, Lin H. Dual-Mobility Cup Total Hip Arthroplasty for Displaced Femoral Neck Fractures: A Retrospective Study With a Median Follow-Up of 5 Years. Geriatr Orthop Surg Rehabil 2021; 12:21514593211013244. [PMID: 34017615 PMCID: PMC8114288 DOI: 10.1177/21514593211013244] [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: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Patient outcomes following modern dual-mobility cup total hip arthroplasty (DM-THA) remains a concern. Few reports have focused on the use of modern DM-THA in the setting of Asian populations for displaced osteoporotic femoral neck fractures (FNFs). This study aimed to investigate the outcomes of Chinese population with displaced osteoporotic FNFs initially treated with modern DM-THA. Materials and Methods: Data from 112 consecutive patients (112 hips) with displaced osteoporotic FNFs initially treated with modern DM-THA during 2011-2018 were retrospectively analyzed. Follow-ups were performed at 3 months, 6 months, 12 months, and then every 1 year after surgery. The primary endpoint was the Harris Hip Score (HHS); the secondary endpoint was the main orthopedic complication rate. Results: The mean HHS improved from 58.62 (±15.79) prior to surgery to 86.13 (±9.92) at the final follow-up. The main complication rate was 14.2% (16/112). Sixteen complications in 10 patients were recorded. Of the 16 complications, there were 2 (1.7%) cases requiring revision DM-THA, 3 (2.6%) cases of loosening, 2 (1.7%) cases of migration, 3 (2.6%) intra-prosthetic dislocation (IPD), 4 (3.5%) cases of tilting, and 2 (1.7%) cases of severe wear. The need for revision was attributed to prosthesis loosening associated with poor bony quality. Conclusion: In patients with displaced osteoporotic FNFs, DM-THA may yield favorable functional outcomes and a low rate of main orthopedic complications, in particular, a low dislocation rate.
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Affiliation(s)
- Zhenfa Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou China
| | - Guixing Xu
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Lei Cao
- Department of Anaesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Sun
- Department of Anaesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Nana Xiong
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Shuxin Wang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Qilong Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
| | - Huanyi Lin
- Department of Urinary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Yuexiu District, Guangzhou, China
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18
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Dremstrup L, Thillemann JK, Kirkeby L, Larsen LP, Hansen TB, Stilling M. Two-year results of the Moovis trapeziometacarpal joint arthroplasty with focus on early complications. J Hand Surg Eur Vol 2021; 46:131-140. [PMID: 32397782 DOI: 10.1177/1753193420921307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this prospective study, we aimed to analyse the early results of 200 consecutive total trapeziometacarpal joint arthroplasties using the Moovis cup, a new generation, dual-mobility, uncemented conical cup, with special focus on early complications. At the 24-month follow-up, we found clinically relevant improvement of function and comfort. Among intraoperative complications were nine intraoperative trapezial fractures, which were treated by screw osteosynthesis; prolonged immobilization; and conversion to cemented cup fixation or primary or secondary trapeziectomy. One was left untreated as the loose cup did not cause notable symptoms. There were three implants with polyethylene wear and two with liner dislocation. We conclude that early outcomes of this new-generation implant are favourable, but its surgery is challenging and associated with important intraoperative and early postoperative complications related to the learning curve. Attentive reaming of the trapezium and careful cup impaction are crucial steps to avoid trapezial fracture and early cup failure. Level of evidence: II.
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Affiliation(s)
- Lene Dremstrup
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark
| | - Janni Kjærgaard Thillemann
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kirkeby
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Bæk Hansen
- Department of Orthopaedics, Hospital Unit West, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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19
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Chalmers BP, Dubin J, Westrich GH. Modular Dual-Mobility Liner Malseating: A Radiographic Analysis. Arthroplast Today 2020; 6:699-703. [PMID: 32923553 PMCID: PMC7475050 DOI: 10.1016/j.artd.2020.07.034] [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: 04/17/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023] Open
Abstract
Background With dislocation as a leading cause for revision after total hip arthroplasty (THA), modular dual-mobility (MDM) constructs are more commonly used at present in an attempt to decrease postoperative instability. With modularity, there is potential for additional complications, including malseating of the liner. The goal of this study was to perform a radiographic analysis on the incidence of MDM liner malseating. Methods We retrospectively identified 305 patients (305 THAs) who underwent primary THA with an MDM liner from a single manufacturer inserted by a single surgeon. One hundred fifty-six (51%) patients were male. The mean age was 68 years, and the mean body mass index was 31 kg/m2. Only patients with both anteroposterior and cross-table lateral radiographs at a minimum of 6 weeks postoperatively were included. Dislocations and reoperations were determined at 1 year after the procedure. All MDM liners were routinely tested intraoperatively with a "4-quadrant test" to assess for proper seating. Results Four (4/305, 1.3%) MDM liners were noted to be radiographically malseated at early follow-up with three (3/147, 2.0%) occurring in a thinner two dimentional (2D) ongrowth shell and only one (1/158, 0.6%) observed in a thicker three dimentional (3D) additively manufactured shell. They were inferiorly prominent by a median of 1.2 mm, best seen on the cross-table lateral radiograph. In patients with at least 1-year follow-up, no MDM liners dissociated and no patients sustained a dislocation. Five (1.6%) patients required reoperation unrelated to the acetabular or MDM construct. Conclusions Surgeons should be aware that malseating of dual-mobility liners may occur. However, with utilization of a consistent surgical technique to test for seating of the liner, the radiographic incidence of MDM liner malseating was low at 1%. Although there were no short-term clinical implications of liner malseating, long-term follow-up is needed.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeremy Dubin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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20
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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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21
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You D, Sepehri A, Kooner S, Krzyzaniak H, Johal H, Duffy P, Schneider P, Powell J. Outcomes of total hip arthroplasty using dual mobility components in patients with a femoral neck fracture. Bone Joint J 2020; 102-B:811-821. [PMID: 32600134 DOI: 10.1302/0301-620x.102b7.bjj-2019-1486.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional THA, and hemiarthroplasty (HA). METHODS We performed a systematic review of all English language articles on THA-DMC published between 2010 and 2019 in the MEDLINE, EMBASE, and Cochrane databases. After the application of rigorous inclusion and exclusion criteria, 23 studies dealing with patients who underwent treatment for a femoral neck fracture using THA-DMC were analyzed for the rate of dislocation. Secondary outcomes included reoperation, periprosthetic fracture, infection, mortality, and functional outcome. The review included 7,189 patients with a mean age of 77.8 years (66.4 to 87.6) and a mean follow-up of 30.9 months (9.0 to 68.0). RESULTS THA-DMC was associated with a significantly lower dislocation rate compared with both THA (OR 0.26; 95% CI 0.08 to 0.79) and HA (odds ratio (OR) 0.27; 95% confidence interval (CI) 0.15 to 0.50). The rate of large articulations and of intraprosthetic dislocation was 1.5% (n = 105) and 0.04% (n = 3) respectively. CONCLUSION THA-DMC when used in patients with a femoral neck fracture is associated with a lower dislocation rate compared with conventional arthroplasty options. There was no increase in the rates of other complication when THA-DMC was used. Future cost analysis and prospective, comparative studies are required to assess the potential benefit of using THA-DMC in these patients. Cite this article: Bone Joint J 2020;102-B(7):811-821.
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Affiliation(s)
- Daniel You
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Aresh Sepehri
- Department of Orthopaedics, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Sahil Kooner
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Halli Krzyzaniak
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Paul Duffy
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - James Powell
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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22
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Neri T, Boyer B, Batailler C, Klasan A, Lustig S, Philippot R, Farizon F. Dual mobility cups for total hip arthroplasty: tips and tricks. SICOT J 2020; 6:17. [PMID: 32553100 PMCID: PMC7301635 DOI: 10.1051/sicotj/2020018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Since its creation in 1974, the Dual Mobility Cup (DMC) has been gaining in popularity, especially in the past decade. This intensive use could lead to inappropriate use and consequently to an increased complication rate. Compliance with conceptual requirements and surgical techniques will prevent the occurrence of complications that can be wrongly attributed to implants. In this context, we feel that it is essential to share our tips and tricks as well as an overview and an explanation of common errors, based on more than 45 years of clinical and research experience. From basic principles, including indications, implant choice and implant compatibility, to surgical tips, in this article orthopedic surgeons will find a practical overview of DMC in order to use it safely and with confidence.
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Affiliation(s)
- Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon - University Jean Monnet Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Bertrand Boyer
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - INSERM U1059 SAINBIOSE, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Antonio Klasan
- North Shore Hospital, 124 Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Sebastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Remi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon - University Jean Monnet Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Frederic Farizon
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - INSERM U1059 SAINBIOSE, avenue Albert Raimond, 42000 Saint-Étienne, France
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23
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Castiello E, Amendola L, Barca P, Tigani D, Caton JH, Neri T, Prudhon JL. Letter to the editor on "Asymptomatic intraprosthetic dual mobility cup dislocation with increased metal ion levels". Arthroplast Today 2020; 6:132-133. [PMID: 32211491 PMCID: PMC7083734 DOI: 10.1016/j.artd.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Emanuela Castiello
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Luca Amendola
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Paolo Barca
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | - Domenico Tigani
- Department of Orthopaedic Surgey, Ospedale Maggiore "Carlo Alberto Pizzardi", Bologna, Italy
| | | | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Etienne, EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon, University Jean Monnet, Saint Etienne, France
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24
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Is Isolated Mobile Component Exchange an Option in the Management of Intraprosthetic Dislocation of a Dual Mobility Cup? Clin Orthop Relat Res 2020; 478:279-287. [PMID: 31794492 PMCID: PMC7438138 DOI: 10.1097/corr.0000000000001055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraprosthetic dislocation is a specific complication of dual mobility cups, although it occurs less frequently with the latest generations of implants. Intraprosthetic dislocation is related to long-term polyethylene wear of the mobile component chamfer and retentive area, leading to a snap-out of the femoral head. With the increased use of dual mobility cups, even in younger and active patients, the management of intraprosthetic dislocation should be defined according to its type. However, no previous studies, except for case reports, have described the strategy to manage long-term wear-related intraprosthetic dislocation, particularly when a dual mobility cup is not loose. QUESTIONS/PURPOSES This study aimed to (1) determine the prevalence of intraprosthetic dislocation in this patient population and the macroscopic findings at the time of surgical revision and (2) evaluate whether isolated mobile component exchange could be an option to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. METHODS From January 1991 to December 2009, a continuous series of 5274 THAs with dual mobility cups (4546 patients; 2773 women; mean [range] age 58 years [22-87]; bilateral THA = 728) were prospectively enrolled in our institutional total joint registry. A cementless, hemispherical dual mobility cup was systematically implanted, regardless of the patient's age or indication for THA. At the latest follow-up examination, the registry was queried to isolate each occurrence of intraprosthetic dislocation, which was retrospectively analyzed regarding the patient's demographics, indication for THA, radiographs, intraoperative findings (polyethylene wear and lesion patterns on the mobile component, periarticular metallosis, and implant damage because of intraprosthetic impingement of the femoral neck), management of intraprosthetic dislocation (isolated exchange of the mobile component or revision of the dual mobility cup), and outcome. RESULTS At a mean (range) follow-up duration of 14 years (3-26), 3% of intraprosthetic dislocations (169 of 5274) were reported, with a mean (range) time from THA of 18 years (13-22). Intraprosthetic dislocation occurred predominantly in younger men (mean [range] age at THA, 42 years [22-64] versus 61 years [46-87]; p < 0.001, and sex ratio (male to female, 1:32 [96 male and 73 female] versus 0.62 [1677 male and 2700 female]; p < 0.001) in patients with intraprosthetic dislocation and those without, respectively, but was not influenced by the indication for THA (105 patients with intraprosthetic dislocation who underwent THA for primary hip osteoarthritis and 64 with other diagnoses versus 3146 patients without who underwent THA for primary hip osteoarthritis and 1959 for other diagnoses (p = 0.9)). In all patients with intraprosthetic dislocation, a macroscopic analysis of the explanted mobile component revealed circumferential polyethylene wear and damage to the chamfer and retentive area, with subsequent loss of retaining power for the femoral head. Nine percent of intraprosthetic dislocations (16 of 169 patients with intraprosthetic dislocations) were associated with aseptic loosening of the dual mobility cup and were managed with acetabular revision without recurrence at a mean (range) follow-up duration of 7.5 years (5-11). Ninety-one percent of intraprosthetic dislocations (153 of 169) were pure, related to wear of the mobile component chamfer and retentive area without aseptic loosening of the dual mobility cup, and managed with isolated mobile component exchange. Intraprosthetic dislocation recurred in 6% (nine of 153) at a mean (range) follow-up interval of 3 years (2-4.5). Additionally, severe premature polyethylene wear of the mobile component with loosening of the dual mobility cup occurred in 12% of patients (19 of 153) at a mean (range) follow-up duration of 1.5 years (0.5-3). CONCLUSIONS A failure rate of 18% (28 of 153 patients undergoing isolated mobile component exchange) was reported within 5 years after isolated mobile component exchange to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. The two modes of failure were early recurrence of intraprosthetic dislocation or severe premature metallosis-related polyethylene wear of the mobile component with loosening of the dual mobility cup. Acetabular revision with synovectomy should remain the standard procedure to manage intraprosthetic dislocation, particularly if periarticular metallosis is present. The exception is intraprosthetic dislocation occurring in elderly or frail patients, for whom a conventional acetabular revision procedure would be associated with an unjustified surgical or anesthetic risk. LEVEL OF EVIDENCE Level II, prognostic study.
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25
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Fessy MH, Jacquot L, Rollier JC, Chouteau J, Ait-Si-Selmi T, Bothorel H, Chatelet JC. Midterm Clinical and Radiographic Outcomes of a Contemporary Monoblock Dual-Mobility Cup in Uncemented Total Hip Arthroplasty. J Arthroplasty 2019; 34:2983-2991. [PMID: 31444020 DOI: 10.1016/j.arth.2019.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The efficacy of contemporary monoblock dual-mobility (DM) cups to prevent dislocations in total hip arthroplasty (THA) is well reported, but there is little published data on their mid- to long-term outcomes. The authors aimed at reporting the 10-year survival of a contemporary DM cup as well as its clinical and radiographic outcomes. METHODS From a retrospective consecutive multicentric series of 516 patients (541 hips) that received uncemented THA between June 2007 and June 2010, 6 patients (6 hips) had cup and stem revisions, 5 patients (5 hips) had isolated stem revision, and 2 patients (2 hips) had isolated insert revision. A total of 103 patients (111 hips) died with their original implants, and 41 patients (42 hips) were lost to follow-up. This left 358 patients (375 hips) for clinical assessment at a median follow-up of 8.7 years (range, 6.8-10.5 years), including 279 patients (290 hips) with postoperative radiographs. Implant survival was calculated using the Kaplan-Meier method, and multivariable analyses were performed to determine whether clinical outcomes are associated with patient or surgical factors. RESULTS The 10-year survival considering revision for aseptic loosening as end point was 100% for the cup and 99.2% for the stem. No dislocations were observed, and radiographic assessment revealed 1 acetabular granuloma (0.3%), but no radiolucencies nor fractures. The Harris hip score improved from 49.6 ± 15.5 to 85.2 ± 14.5, and the postoperative Oxford hip score was 19.2 ± 7.6. Multivariable analyses revealed that improvement in Harris hip score increased with cup diameter (beta, 1.28; P = .039). CONCLUSION Our data confirmed satisfactory midterm outcomes of uncemented THA using a contemporary DM cup, with no dislocations nor cup revisions due to aseptic loosening. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Michel-Henri Fessy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France; Artro Group Institute, Lyon, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Julien Chouteau
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Tarik Ait-Si-Selmi
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Centre de Chirurgie Orthopédique du Beaujolais, Arnas, France
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26
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Gaillard R, Kenney R, Delalande JL, Batailler C, Lustig S. Ten- to 16-Year Results of a Modern Cementless Dual-Mobility Acetabular Implant in Primary Total Hip Arthroplasty. J Arthroplasty 2019; 34:2704-2710. [PMID: 31353249 DOI: 10.1016/j.arth.2019.06.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/06/2019] [Accepted: 06/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to assess the radiographic results, clinical outcomes, and survivorship of a modern cementless dual-mobility cup (DMC) implant as a primary THA with a minimum of 10 years follow-up. METHODS This study retrospectively assessed a series of 310 primary THAs using a modern-generation cementless DMC (Saturne acetabular cup) between April 2001 and December 2005 at a single center. Patients were followed prospectively clinically and radiographically after surgery. Hips with follow-up less than 120 months were excluded from the study (5 lost to follow-up and 167 deceased). In total, a cohort of 138 hips were included for preoperative and postoperative analysis with an average follow-up of 152.4 months. All complications were collected, and a Kaplan-Meier survival analysis was performed. RESULTS There was a significant increase in the mean Harris and Postel-Merle d'Aubigne scores between preoperative and postoperative cohorts (P < .001). No loosening of the cup and no acetabular osteolysis were found at final follow-up. No prosthetic dislocation, no intraprosthetic dislocation, and no infections were reported. The survival curve of THA in the total cohort (N = 310) was about 98% at 10 years with 3 stem revisions for femoral fracture. One psoas impingement was also described. CONCLUSION This study showed no acetabular component failure and no reported cases of acetabular osteolysis with this DMC acetabular component retention at 10 years. No prosthetic or intraprosthetic dislocation was reported.
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Affiliation(s)
| | - Raymond Kenney
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY
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27
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Addona JL, Gu A, De Martino I, Malahias MA, Sculco TP, Sculco PK. High Rate of Early Intraprosthetic Dislocations of Dual Mobility Implants: A Single Surgeon Series of Primary and Revision Total Hip Replacements. J Arthroplasty 2019; 34:2793-2798. [PMID: 31402075 DOI: 10.1016/j.arth.2019.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dual mobility (DM) articulations have become an increasingly popular bearing choice in efforts to reduce dislocation rates in high risk primary and revision total hip arthroplasties (THA). However, DM dislocations can still occur. Intraprosthetic dislocation (IPD) is a unique failure mode for DM compared to standard femoral heads. Currently, the incidence of this phenomenon during attempted hip reduction is unknown. METHODS A retrospective analysis of a consecutive series of all primary, revision, and conversion THA procedures performed by a single surgeon was collected. For all dislocations, patient demographics, location where reduction was performed, type of anesthetic used was recorded. For DM dislocations, the rate of successful closed reduction, reoperation due to failure of closed reduction, and incidence of IPD at time of reduction was recorded. Descriptive statistics were conducted on the data. RESULTS In total, 527 cases were included for analysis. The overall rate of dislocation (with and without DM) was 2.85%. Among DMs, the dislocation rate was 4.55%. The rate of IPD after closed reduction was 5/7 (71%) with all five requiring revision surgery to either another DM bearing or constrained liner. CONCLUSIONS We report a high rate of early IPD after DM dislocation. This study supports alternative treatment protocols for these patients including regional or general anesthesia to be administered in the operating room and for the reduction to be performed under fluoroscopy. Dislocated DM components handled in this manner could reduce the high incidence of IPD reported.
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Affiliation(s)
- Jacqueline L Addona
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Alex Gu
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Ivan De Martino
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Michael-Alexander Malahias
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Thomas P Sculco
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
| | - Peter K Sculco
- Department of Orthopedic Surgery, The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY
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Assi C, Caton J, Fawaz W, Samaha C, Yammine K. Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups. INTERNATIONAL ORTHOPAEDICS 2018; 43:2245-2251. [PMID: 30370452 DOI: 10.1007/s00264-018-4209-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting. MATERIALS AND METHODS This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months. RESULTS Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed. CONCLUSION The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | | | - Wissam Fawaz
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon. .,Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon.
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