Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups

Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review

Background: Instability is a common complication following total hip arthroplasty (THA). The dual mobility cup (DMC) allows a reduction in the dislocation rate. The goal of this systematic review was to clarify the different uses and outcomes according to the indications of the cemented DMC (C-DMC). Methods: A systematic review was performed using the keywords "Cemented Dual Mobility Cup" or "Cemented Tripolar Cup" without a publication year limit. Of the 465 studies identified, only 56 were eligible for the study. Results: The overall number of C-DMC was 3452 in 3426 patients. The mean follow-up was 45.9 months (range 12-98.4). In most of the cases (74.5%) C-DMC was used in a revision setting. In 57.5% DMC was cemented directly into the bone, in 39.6% into an acetabular reinforcement and in 3.2% into a pre-existing cup. The overall dislocation rate was 2.9%. The most frequent postoperative complications were periprosthetic infections (2%); aseptic loosening (1.1%) and mechanical failure (0.5%). The overall revision rate was 4.4%. The average survival rate of C-DMC at the last follow-up was 93.5%. Conclusions: C-DMC represents an effective treatment option to limit the risk of dislocations and complications for both primary and revision surgery. C-DMC has good clinical outcomes and a low complication rate.

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

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.

Influence of dual-mobility acetabular implants on revision and survivorship of cup and Kerboull-type reinforcement ring constructs in aseptic acetabular loosening

INTRODUCTION

Dual-mobility (DM) acetabular implants have been used in revision total hip arthroplasty (THA) to prevent postoperative instability, with excellent mid-term survivorship. However, few comparative studies assessed the long-term outcomes of DM implants used in Kerboull-type reinforcement ring constructs for acetabular revision. The present study aimed to compare long-term survivorship, dislocation rates and clinical outcome between DM acetabular implants and conventional single-bearing (SB) implants when cemented in a reinforcement ring.

HYPOTHESIS

Dual-mobility implants are associated with equivalent survivorship and lower dislocation rates than SB implants.

MATERIAL AND METHODS

A retrospective study included 60 revision THAs for aseptic loosening using a Kerboull-type reinforcement ring, and finally included 2 groups of 23 patients with either DM or SB cemented acetabular implants after matching for age, gender, BMI and preoperative Harris hip score. Mean follow-up was 10 years (range, 6-14 years). Acetabular implant survivorship, dislocation rate and radiographic failure incidence (>5mm migration, progressive radiolucency, graft non-integration, reinforcement ring breakage) were compared between the two groups. Clinical outcomes used the Harris hip score, the Postel-Merle d'Aubigné score and the Parker score.

RESULTS

Survivorship free of aseptic acetabular re-revision was 89% at 10 years, with no significant difference between DM and SB (91% and 86%, respectively; p=0.54). Single-bearing implants showed a hazard ratio for dislocation of 6.7 (95% CI, 1.5-29.6; p=0.01) compared to DM implants. There were no significant differences in radiologic failure (10-year survivorship 72% and 64%, respectively; p=0.88) or functional scores.

DISCUSSION

The present study confirmed the impact of dual-mobility implants in reducing long-term dislocation risk when used in Kerboull-type reinforcement ring constructs for acetabular aseptic revision, with no increased risk of re-revision compared to conventional single-bearing implants.

LEVEL OF EVIDENCE

III, comparative retrospective study.

Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis

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.

Dual mobility for total hip arthroplasty revision surgery: A systematic review and metanalysis

INTRODUCTION

Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties.

METHODS

A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery.

RESULTS

Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection.

DISCUSSION

A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant's Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA.

Dual Mobility Bearing Articulations Result in Lower Rates of Dislocation After Revision Total Hip Arthroplasty

INTRODUCTION

The purpose of our study is to directly compare the rates of instability after revision total hip arthroplasty (THA) between a modular dual mobility (DM) and a conventional polyethylene single-bearing surface.

METHODS

We retrospectively reviewed a consecutive series of patients who underwent revision THA from 2012 to 2016 at a single institution with a minimum of 2 years of follow-up. Rates of re-revision, dislocation, complications, and short-form (SF-12) scores were compared between the DM and single-bearing groups. To control for confounding variables, a multivariate logistic regression analysis was performed.

RESULTS

Of the 267 revision THA patients, 94 patients had a DM bearing articulation (36%), whereas 173 patients (64%) had a conventional single-bearing with a mean follow-up of 37.8 months (range 24 to 73 months). The DM group was more likely to undergo revision THA for instability compared with the single-bearing group (8.5% versus 1.2%, P ≤ 0.005) but had reduced incidence of postoperative dislocations (2.1% versus 8.7%, P = 0.067) and no difference in the rates of re-revisions (9.6% versus 11.6%, P = 0.770). When controlling for confounding variables, patients who received a DM liner had lower rates of dislocation postoperatively than those of single-bearing (odds ratio 0.12, P = 0.019).

DISCUSSION

Even with a selection bias of surgeons using DM for patients at high risk of instability, patients undergoing revision THA with a DM bearing have reduced rates of dislocation at the intermediate-term follow-up. Further study is needed to identify any potential longer-term complications which may result from a modular DM bearing.

Posterior versus direct anterior approach in revision hip arthroplasty using Kerboull-type plate

Introduction: The purpose of this study was to investigate revision with a Kerboull-type plate through the posterior approach (PA) and direct anterior approach (DAA) and compare the clinical outcome.

Subjects and methods: Fifty-four patients (56 hip joints) underwent revision surgery in which acetabular reconstruction was performed concomitantly using the Kerboull-type plate and allogeneic bone. Revision surgery through DAA was performed in 21 hip joints and these were compared with 34 hip joints treated through PA. There was no significant difference in the patient demographics between the DAA and PA.

Results: There was no significant difference between the operative times in the DAA and PA groups (203.2 ± 43.5 and 211.7 ± 41.8 min). There was a significant difference between the intraoperative blood loss in the DAA and PA groups (503.9 ± 223.7 mL and 703.8 ± 329.6 mL, respectively, p < 0.05). There was no significant difference between the modified Harris Hip Score in the DAA and the PA groups. The loosening of the acetabular component was observed in four cases (11.8%) in the PA group. In the DAA and PA groups, the 5-year survival rates were 100 and 85.7%, respectively. Recurrent dislocation of the hip was observed in six cases (one case in the DAA group (4.8%) and five cases in the PA group (14.7%)).

Conclusions: It was verified that the difference in the surgical approach of acetabular reconstruction concomitantly using the Kerboull-type plate and allogeneic bone graft influenced the postoperative outcome.