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Hidayat T, Ammarullah MI, Ismail R, Saputra E, Lamura MDP, K N C, Bayuseno AP, Jamari J. Investigation of contact behavior on a model of the dual-mobility artificial hip joint for Asians in different inner liner thicknesses. World J Orthop 2024; 15:321-336. [PMID: 38680676 PMCID: PMC11045469 DOI: 10.5312/wjo.v15.i4.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/28/2024] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND The four components that make up the current dual-mobility artificial hip joint design are the femoral head, the inner liner, the outer liner as a metal cover to prevent wear, and the acetabular cup. The acetabular cup and the outer liner were constructed of 316L stainless steel. At the same time, the inner liner was made of ultra-high-molecular-weight polyethylene (UHMWPE). As this new dual-mobility artificial hip joint has not been researched extensively, more tribological research is needed to predict wear. The thickness of the inner liner is a significant component to consider when calculating the contact pressure. AIM To make use of finite element analysis to gain a better understanding of the contact behavior in various inner liner thicknesses on a new model of a dual-mobility artificial hip joint, with the ultimate objective of determining the inner liner thickness that was most suitable for this particular type of dual-mobility artificial hip joint. METHODS In this study, the size of the femoral head was compared between two diameters (28 mm and 36 mm) and eight inner liner thicknesses ranging from 5 mm to 12 mm. Using the finite element method, the contact parameters, including the maximum contact pressure and contact area, have been evaluated in light of the Hertzian contact theory. The simulation was performed statically with dissipated energy and asymmetric behavior. The types of interaction were surface-to-surface contact and normal contact behavior. RESULTS The maximum contact pressures in the inner liner (UHMWPE) at a head diameter of 28 mm and 36 mm are between 3.7-13.5 MPa and 2.7-10.4 MPa, respectively. The maximum von Mises of the inner liner, outer liner, and acetabular cup are 2.4-11.4 MPa, 15.7-44.3 MPa, and 3.7-12.6 MPa, respectively, for 28 mm head. Then the maximum von Mises stresses of the 36 mm head are 1.9-8.9 MPa for the inner liner, 9.9-32.8 MPa for the outer liner, and 2.6-9.9 MPa for the acetabular cup. A head with a diameter of 28 mm should have an inner liner with a thickness of 12 mm. Whereas the head diameter was 36 mm, an inner liner thickness of 8 mm was suitable. CONCLUSION The contact pressures and von Mises stresses generated during this research can potentially be exploited in estimating the wear of dual-mobility artificial hip joints in general. Contact pressure and von Mises stress reduce with an increasing head diameter and inner liner's thickness. Present findings would become one of the references for orthopedic surgery for choosing suitable bearing geometric parameter of hip implant.
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Affiliation(s)
- Taufiq Hidayat
- Department of Mechanical Engineering, Universitas Muria Kudus, Kudus 59352, Central Java, Indonesia
- Department of Mechanical Engineering, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Muhammad Imam Ammarullah
- Department of Mechanical Engineering, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Rifky Ismail
- Department of Mechanical Engineering, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
- Center for Biomechanics Biomaterials Biomechatronics and Biosignal Processing, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Eko Saputra
- Department of Mechanical Engineering, Politeknik Negeri Semarang, Semarang 50275, Central Java, Indonesia
| | - M Danny Pratama Lamura
- Department of Mechanical Engineering, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
| | - Chethan K N
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | | | - J Jamari
- Department of Mechanical Engineering, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre, Universitas Diponegoro, Semarang 50275, Central Java, Indonesia
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Cantrell AJ, Forrester DA, Crawford AW, Morris C, Thakral R. Intraprosthetic Dislocation of a Modular Dual-Mobility Total Hip Arthroplasty With Posterior Migration of the Polyethylene Liner. Arthroplast Today 2024; 25:101290. [PMID: 38298810 PMCID: PMC10827604 DOI: 10.1016/j.artd.2023.101290] [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: 06/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2024] Open
Abstract
Dual-mobility (DM) implants have been used in total hip arthroplasty since 1974. Modular DM implants have seen an increase in use in primary and revision total hip arthroplasties given the theoretical decreased dislocation rate. DM constructs have 2 articulation sites, one between the acetabular shell and a polyethylene liner, as well as one between the liner and the femoral head component. However, dislocations with modular DM implant dislocations can still occur. These dislocations occur via an extraprosthetic or intraprosthetic mechanism. Intraprosthetic dislocation is a phenomenon in which the smaller femoral head dissociates from the polyethylene liner. We present a case of intraprosthetic dislocation in an 81-year-old female with migration of the polyethylene liner into her gluteal muscles after 2 attempted closed reductions.
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Affiliation(s)
- Austin J. Cantrell
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - D. Alex Forrester
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alexander W. Crawford
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cade Morris
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rishi Thakral
- Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Dubin JA, Westrich GH. Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty. Hip Int 2024; 34:15-20. [PMID: 36891584 DOI: 10.1177/11207000231158722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients. METHODS From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM). RESULTS The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p < 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up. CONCLUSIONS This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.
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Affiliation(s)
- Jeremy A Dubin
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Ballard T, Corbett A, Murphy JD, Judson W, Harker JN. A Missed Diagnosis of Intraprosthetic Dislocation in a Dual-Mobility Bearing Following Closed Reduction. Cureus 2023; 15:e49361. [PMID: 38143637 PMCID: PMC10749215 DOI: 10.7759/cureus.49361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/26/2023] Open
Abstract
Dual-mobility bearings have been found to reduce the rate of dislocation following both primary and revision total hip arthroplasty. Their unique design involves two articulating surfaces which increases construct stability but also leaves them susceptible to a unique complication known as intraprosthetic dislocation (IPD). We report the case of a 33-year-old female who sustained an IPD following closed reduction. Following a missed radiographic diagnosis, the patient experienced pain and mechanical symptoms secondary to her implant failure. Surgical removal of the dislodged liner with component revision was required. This case highlights several crucial steps in the management of patients with dislocated total hip arthroplasties including implant identification and careful review of postreduction radiographs. We also discuss several strategies to properly diagnose, manage, and avoid IPD.
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Affiliation(s)
| | | | - John D Murphy
- Orthopedic Surgery, Largo Medical Center, Largo, USA
| | | | - John N Harker
- Orthopedic Surgery, Largo Medical Center, Largo, USA
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Dubin JA, Bains SS, Chen Z, Hameed D, Moore MC, Mont MA, Nace J, Delanois RE. Single center evaluation of outcomes of modular dual mobility liners during revision total hip arthroplasty: A five-year follow-up. J Orthop 2023; 43:75-78. [PMID: 37559883 PMCID: PMC10407033 DOI: 10.1016/j.jor.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Revision total hip arthroplasty (rTHA) is at increased risk for postoperative instability when compared to primary cases, which has been mitigated to some extent with the introduction of dual mobility (DM) reconstructions. These constructs were designed to lower dislocation rates and to improve impingement-free range of motion. As a follow-up to our prior institutional study, we expanded on a cohort of DM reconstructions compared to non-DM constructs. We examined a modular dual mobility system in rTHA to measure loosening of the acetabular component, as well as revision and dislocation rates in comparison to an historical cohort of single articulation prostheses.Materials/Methods: This retrospective cohort study from a single center included 254 patients who underwent rTHA with a dual mobility liner by three fellowship-trained surgeons between January 1, 2014 and December 1, 2019. This was a follow-up to an historical cohort of revisions performed with a single articulation prosthesis (n = 120) from the same surgeons performed between January 1, 2011 and December 23, 2013. The inclusion criteria included consecutively performed rTHAs that had a minimum follow-up of 2 years. We excluded patients who had femoral revisions and head/liner revisions only. The average follow-up in the dual mobility cohort and the single articulation cohort was 5 years (range, 2-10 years) and 2.5 years (range, 1.5-4.3 years), respectively. The primary outcomes were dislocation, aseptic loosening, and re-revision rates. Secondary outcomes were radiographic analyses of cup migration and osteolysis. RESULTS There were 4 out of 256 (1.6%) dislocations from the dual mobility cohort compared to 7 out of 120 (5.8%), P < 0.001 from the single articulation cohort. The rates of aseptic loosening were 3.2% (8 out of 254) and 4.2% (5 out of 120), P = 0.124, respectively, between the cohorts. The re-revision rate was 5.9% for the DM liners and 8.3% in the control cohort, P = 0.38. Radiographic analyses revealed no cup migration and osteolysis in any of the patients that had no dislocations. CONCLUSION The dual mobility articulations in rTHA demonstrated improved results in terms of lower dislocations rates when compared to a single articulation prostheses. Our center uses these articulations for revisions and surgeons should consider the use of these bearings when performing rTHA.
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Affiliation(s)
- Jeremy A. Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Mallory C. Moore
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Michael A. Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Ronald E. Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Tigani D, Banci L, Stallone S, Melucci G, Pieratelli G, Castiello E. Evolution and New Generation of Dual Mobility Cups. Orthopedics 2023; 46:e273-e280. [PMID: 37561099 DOI: 10.3928/01477447-20230804-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Although total hip arthroplasty (THA) is considered a successful procedure, hip dislocation remains the main cause of early failure. Dual mobility cups (DMCs) have been shown to significantly reduce the dislocation rate in both primary and revision THAs. During the past several decades, DMCs have evolved in design and fixation interface. There have been three generations of DMCs. This article addresses the rationale for a new cementless highly porous titanium DMC to improve component fixation and implant biocompatibility. [Orthopedics. 2023;46(5):e273-e280.].
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Ciriello V, La China R, Chirillo DF, Bianco G, Fusini F, Scarlato U, Albanese C, Bonzanini G, Banci L, Piovani L. Is Modular Dual Mobility Superior to Standard Bearings for Reducing Dislocation Risk after Primary Total Hip Arthroplasty? A Retrospective Comparative Multicenter Study. J Clin Med 2023; 12:4200. [PMID: 37445235 DOI: 10.3390/jcm12134200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Dual mobility (DM) has been proven to reduce dislocation risk after total hip arthroplasty (THA). In the last decade modular DM (modDM) constructs have been introduced to allow the use of DM articulation with standard cementless acetabular shells. However, clinical evidence of modDM effectiveness is still low in primary THA and concerns about implant-related complications are increasing. This retrospective comparative multicenter study is aimed to investigate if the dislocation rate after primary THA could be reduced with modDM in comparison to standard bearing (SB). METHODS 262 THAs were performed between 2017 and 2019, using SB (129 hips) or modDM (133) with the same cementless highly porous modular acetabular cup. Dislocations, complications and revisions were recorded and implant survival was analyzed. RESULTS At 2.5-year mean follow-up, dislocation occurred in 4 hips (3.1%) within the SB group while intraprosthetic dislocation in 2 hips (1.5%) within the modDM group (p = 0.44). Implant survivals with revision due to dislocation were 95.2% and 95.9% at 4-year follow-up for SB and modDM, respectively (p = 0.50). CONCLUSIONS modDM used in primary THA might reduce dislocation rate in comparison to SB, even in high-risk patients, however, caution is advocated due to specific intraprosthetic dislocation.
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Affiliation(s)
- Vincenzo Ciriello
- Ortopedia e Traumatologia, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
| | - Roberta La China
- Ortopedia e Traumatologia, Ospedale Santo Spirito, 15033 Casale Monferrato, Italy
| | | | - Giuseppe Bianco
- Ortopedia e Traumatologia, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy
| | - Federico Fusini
- Ortopedia e Traumatologia, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy
| | - Ugo Scarlato
- Ortopedia e Traumatologia, Ospedale Civile, 10015 Ivrea, Italy
| | - Carlo Albanese
- Ortopedia e Traumatologia, Ospedale Civile, 10015 Ivrea, Italy
| | - Giancarlo Bonzanini
- Ortopedia e Traumatologia, Ospedale Sant'Antonio e Margherita, 15057 Tortona, Italy
| | - Lorenzo Banci
- Clinical Research Department, Permedica Orthopaedics, 23807 Merate, Italy
| | - Lucio Piovani
- Ortopedia e Traumatologia, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy
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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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Butler JT, Stegelmann SD, Butler JL, Bullock M, M Miller R. Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review. J Orthop Surg Res 2023; 18:226. [PMID: 36945061 PMCID: PMC10032016 DOI: 10.1186/s13018-023-03724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Dual mobility components can be implanted during total hip arthroplasty (THA) for primary osteoarthritis via a direct anterior approach (DAA), anterolateral approach (ALA), direct lateral approach (DLA), or posterior/posterolateral approach (PLA). This review compares dual mobility hip dislocation rates using these approaches for elective primary THA. METHODS PubMed, Embase, and Cochrane databases were systematically searched for articles published after January 1, 2006 that reported dislocation rates for adult patients after primary THA with dual mobility implants. Articles were excluded if they reported revision procedures, nonelective THA for femoral neck fractures, acetabular defects requiring supplemental implants, prior surgery, or ≤ 5 patients. The primary outcome was hip dislocation rate. Secondary outcomes included infection, Harris Hip Score (HHS), and Postel-Merle d'Aubigné (PMA) score. RESULTS After screening 542 articles, 63 met inclusion criteria. Due to study heterogeneity, we did not perform a meta-analysis. Eight studies reported DAA, 5 reported ALA, 6 reported the DLA, and 56 reported PLA. Study size ranged from 41 to 2,601 patients. Mean follow-up time ranged from 6 months to 25 years. Rates of infection and dislocation were low; 80% of ALA, 87.5% of DAA, 100% of DLA, and 82.1% of PLA studies reported zero postoperative dislocations. Studies reporting postoperative HHS and PMA scores showed considerable improvement for all approaches. CONCLUSIONS Patients undergoing primary THA with dual mobility implants rarely experience postoperative dislocation, regardless of surgical approach. Additional studies directly comparing DAA, ALA, DLA, and PLA are needed to confirm these findings.
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Affiliation(s)
- Justin T Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA.
| | - Samuel D Stegelmann
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Johnathon L Butler
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
| | - Matthew Bullock
- Department of Orthopedic Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Richard M Miller
- Department of Orthopedic Surgery, Mercy Health St. Vincent Medical Center, 2409 Cherry St, Suite #10, Toledo, OH, 43608, USA
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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: 0] [Impact Index Per Article: 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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Yang J, Bryan AJ, Drabchuk R, Tetreault MW, Calkins TE, Della Valle CJ. Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation. Hip Int 2022; 32:648-655. [PMID: 33566709 DOI: 10.1177/1120700020988469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA. METHODS A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3). RESULTS There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%). DISCUSSION Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.
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Affiliation(s)
- JaeWon Yang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Andrew J Bryan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W Tetreault
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Baker CM, Restrepo C, Hozack WJ. Minimum Five-Year Outcomes of Modular Dual Mobility in Primary Total Hip Arthroplasty. J Arthroplasty 2022; 37:S566-S570. [PMID: 35271978 DOI: 10.1016/j.arth.2022.02.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Using a modular dual-mobility (MDM) bearing in primary total hip arthroplasty (THA) has not been widely evaluated. The purpose of this study is to evaluate clinical outcomes and survivorship following MDM bearings in primary THA. METHODS We used our registry database for patients with an MDM bearing on primary THA, performed by 6 surgeons through supine direct lateral or direct anterior approach. MDM bearings were used most often when impingement or subluxation was present intraoperatively despite proper component position. Another indication was a patient with planned activities who might be at a higher risk of instability postoperatively. RESULTS A total of 127 MDM bearings were used in primary THA in 119 patients. Mean follow-up was 6.77 years (range 5-8.9). Five hips were revised, none of which were due to MDM bearing failure. Preoperative Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Veterans RAND/Short Form 12 Physical Health Score and Mental Health Score increased from 25.81 to 52.40 (P < .0001), 30.42 to 44.50 (P < .0001), and 36.21 to 52.70 (P < .0001) at latest completed survey follow-up, respectively. CONCLUSION This MDM bearing shows excellent functional outcomes at a minimum 5 years of follow-up with no bearing-related failures. It can be an excellent choice in primary THA specifically in females where the use of increased head size to prevent instability is not possible due to anatomical restrictions and liner thickness.
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Affiliation(s)
- Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Camilo Restrepo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - William J Hozack
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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13
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Epinette JA, Coulomb R, Pradel S, Kouyoumdjian P. Do Modular Dual Mobility Cups Offer a Reliable Benefit? Minimum 5-Year Follow-Up of 102 Cups. J Arthroplasty 2022; 37:910-916. [PMID: 35065216 DOI: 10.1016/j.arth.2022.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Among various options suggested to prevent hip instability after total hip replacement, the MDM-tritanium (modular dual mobility) cup features a cobalt-chrome liner (CoCr) positioned in a titanium acetabular shell and matched with a mobile insert in highly cross-linked annealed X3 polyethylene. The purpose of this study aimed to confirm whether there was no significant release of ions (Co and Cr) or higher occurrence of dislocation or even cases of aseptic loosening of the cementless shell with the use of MDM-tritanium cups at minimum of 5-year follow-up. METHODS The clinical study was carried out on a homogeneous consecutive and nonselective series with 102 MDM cups (98 patients) implanted in 2 centers. This MDM-tritanium cup had been systematically used for surgical revisions (70% of cases) or for patients with major hip dysplasia or in elderly patients with poor bone quality. A biological assessment of ion releases has been performed in a specific cohort of 39 cases that had an internal ceramic head. RESULTS None of the following complications was observed: no case of immunoallergic event, no aseptic loosening, and the dislocation rate was 4.9% involving only the difficult primary and revision cases. The clinical results were encouraging, with 89.7 points for Harris Hip Score, 41.16 points/48 for the OHS-12. The Agora Roentgenographic Assessment (ARA) radiologic score was graded "excellent" in 94.4%. The MDM-tritanium survivorship with revision for any cause in 102 cups at 7.95 years was 92.7%. CONCLUSION Based on the results of our first 102 cases, there were no immunoallergic complications-contrary to what was initially feared with the CoCr bearing-titanium pair-and no postoperative instability, including for complex primary and revisions total hip replacements. LEVEL OF EVIDENCE Individual Cohort Study: 2B.
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Affiliation(s)
| | - Remy Coulomb
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France
| | - Sarah Pradel
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France
| | - Pascal Kouyoumdjian
- Department of Orthopaedic Surgery, University Hospital of Nîmes, Nîmes, France; Laboratory of Mechanics and Civil Engineering (LMGC), CNRS-UM1, Montpellier, France
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14
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Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation. BMC Musculoskelet Disord 2022; 23:373. [PMID: 35443656 PMCID: PMC9022332 DOI: 10.1186/s12891-022-05280-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background Use of dual mobility (DM) in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility (modDM) systems were introduced to give the possibility to use DM with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation change with modDM. The objective of this study was to evaluate, through analytical simulation, how jumping distance, center of rotation and arc of movement change between DM and standard cups with modDM or fixed bearings (FB). Methods 3D-models of DM and standard press-fit cups with modDM or FB liners were used to simulate DM, modDM and FB implant configurations, matched for same cup size, according to same cup position and different femoral head diameters. Jumping distance was calculated and center of rotation lateralization and oscillation angles were measured for each size of these three implant configurations. Results Jumping distance with modDM was reduced by -3.9 mm to -8.6 mm in comparison with DM, from 48 to 64 mm size, but resulted comparable to polyethylene 36 mm FB and increased by + 1.1 mm and + 1.4 mm than ceramic 36 and 40 mm FBs for sizes > 54 mm. ModDM lateralized the center of rotation up to + 2.5 mm and + 4.0 mm in comparison with DM and FBs, respectively. Oscillation angle with modDM resulted higher than + 16°, + 23°, + 17° and + 14° in comparison to DM, 28 mm, 32 mm and 36 mm FB cups, respectively, for 56 mm cup size. Conclusions According to its specific design, modDM might change hip stability parameters in comparison to DM, worsening jumping distance and center of rotation position, but increasing arc of movement. As not restoring stability parameters in the same fashion, modDM implants should be properly used when DM cups are not feasible.
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15
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Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2022; 46:789-795. [DOI: 10.1007/s00264-021-05280-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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16
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Monobloc Dual Mobility With a Minimum 5-Year Follow-Up: A Safe and Effective Solution in Primary Total Hip Arthroplasty. J Arthroplasty 2022; 37:83-88. [PMID: 34593287 DOI: 10.1016/j.arth.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/29/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Instability constitutes over 20% of revisions after total hip arthroplasty (THA). Dual mobility (DM) designs were introduced as a solution to this problem. However, the few publications that have reported promising results for monobloc DM constructs have been limited by sample size or length of follow-up. The purpose of this study is to evaluate mid-term outcomes (minimum 5-year follow-up) of a single-surgeon series utilizing a monobloc DM acetabular component in patients with high risk for dislocation. METHODS This is a single-surgeon consecutive series of 207 primary THAs implanted with a monobloc DM component in patients who were considered at high risk for dislocation. Patient demographics and case-specific data were collected retrospectively. All patients had a minimum of 5-year follow-up. The Mann-Whitney U test was used to assess continuous variables, whereas categorical variables were analyzed using the chi-square test. Survival probability was calculated using the Kaplan-Meier method. RESULTS Radiographic analysis did not reveal acetabular radiolucency in any patients, and there were no revisions for aseptic loosening. In addition, there were no dislocations. Seven of 205 patients (3.4%) were revised, 5 on the femoral side due to periprosthetic fracture and the remaining two for infection. Survivorship of the acetabular component from revision was 99%. The mean Veteran RAND (VR-12) physical score improved from 7 (standard deviation [SD]: 13.7) preoperatively to 9.5 (SD: 17.6) at the final follow-up. Similarly, the hip disability osteoarthritis score improved from 8 (SD: 17.9) preoperatively to 21.2 (SD: 37). CONCLUSION Monobloc DM components reliably prevent dislocation after primary THA in high-risk patients. At mid-term follow-up, this DM monobloc component demonstrates excellent implant survivorship, radiographic fixation, and improved functional outcomes.
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17
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Singh V, Loloi J, Macaulay W, Hepinstall MS, Schwarzkopf R, Aggarwal VK. Dual-mobility versus Fixed-bearing in Primary Total Hip Arthroplasty: Outcome Comparison. Hip Pelvis 2022; 34:96-105. [PMID: 35800126 PMCID: PMC9204238 DOI: 10.5371/hp.2022.34.2.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose Use of dual mobility (DM) articulations can reduce the risk of instability in both primary and revision total hip arthroplasty (THA). Knowledge regarding the impact of this design on patient-reported outcome measures (PROMs) is limited. This study aims to compare clinical outcomes between DM and fixed bearing (FB) prostheses following primary THA. Materials and Methods All patients who underwent primary THA between 2011-2021 were reviewed retrospectively. Patients were separated into three cohorts: FB vs monoblock-D vs modular-DM. An evaluation of PROMs including HOOS, JR, and FJS-12, as well as discharge-disposition, 90-day readmissions, and revisions rates was performed. Propensity-score matching was performed to limit significant demographic differences, while ANOVA and chi-squared test were used for comparison of outcomes. Results Of the 15,184 patients identified, 14,652 patients (96.5%) had a FB, 185 patients (1.2%) had a monoblock-DM, and 347 patients (2.3%) had a modular-DM prosthesis. After propensity-score matching, a total of 447 patients were matched comparison. There was no statistical difference in the 90-day readmission (P=0.584), revision rate (P=0.265), and 90-day readmission (P=0.365) and revision rate due to dislocation (P=0.365) between the cohorts. Discharge disposition was also non-significant (P=0.124). There was no statistical difference in FJS-12 scores at 3-months (P=0.820), 1-year (P=0.982), and 2-years (P=0.608) between the groups. Conclusion DM bearings yield PROMs similar to those of FB implants in patients undergoing primary THA. Although DM implants are utilized more often in patients at higher-risk for instability, we suggest that similar patient satisfaction may be attained while achieving similar dislocation rates.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Jeremy Loloi
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vinay K. Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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18
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Kunze KN, Premkumar A, Bovonratwet P, Sculco PK. Acetabular Component and Liner Selection for the Prevention of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2021; 9:01874474-202112000-00004. [PMID: 34910697 DOI: 10.2106/jbjs.rvw.21.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty. » Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time. » The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options. » Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners). » Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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19
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Lygrisse KA, Matzko C, Shah RP, Macaulay W, Cooper JH, Schwarzkopf R, Hepinstall MS. Femoral Neck Notching in Dual Mobility Implants: Is This a Reason for Concern? J Arthroplasty 2021; 36:2843-2849. [PMID: 33875287 DOI: 10.1016/j.arth.2021.03.043] [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] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dual mobility (DM) total hip arthroplasty (THA) implants have been advocated for patients at risk for impingement due to abnormal spinopelvic mobility. Impingement against cobalt-chromium acetabular bearings, however, can result in notching of titanium femoral stems. This study investigated the incidence of femoral stem notching associated with DM implants and sought to identify risk factors. METHODS A multicenter retrospective study reviewed 256 modular and 32 monoblock DM components with minimum 1-year clinical and radiographic follow-up, including 112 revisions, 4 conversion THAs, and 172 primary THAs. Radiographs were inspected for evidence of femoral notching and to calculate acetabular inclination and anteversion. Revisions and dislocations were recorded. RESULTS Ten cases of femoral notching were discovered (3.5%), all associated with modular cylindrospheric cobalt-chromium DM implants (P = .049). Notches were first observed radiographically at mean 1.3 years after surgery (range 0.5-2.7 years). Notch location was anterior (20%), superior (60%), or posterior (20%) on the prosthetic femoral neck. Notch depth ranged from 1.7% to 20% of the prosthetic neck diameter. Eight cases with notching had lumbar pathology that can affect spinopelvic mobility. None of these notches resulted in stem fracture, at mean 2.7-year follow-up (range 1-7.6 years). There were no dislocations or revisions in patients with notching. CONCLUSION Femoral notching was identified in 3.5% of DM cases, slightly surpassing the dislocation rate in a cohort selected for risk of impingement and instability. Although these cases of notching have not resulted in catastrophic failures thus far, further study of clinical sequelae is warranted. Component position, spinopelvic mobility, and implant design may influence risk.
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Affiliation(s)
| | - Chelsea Matzko
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia Univeristy Irving Medical Center, New York, NY
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - John H Cooper
- Department of Orthopedic Surgery, Columbia Univeristy Irving Medical Center, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
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20
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Spece H, Ouellette ES, Jones OL, MacDonald DW, Piuzzi NS, Lee GC, Mont MA, Klein GR, Kurtz SM. Fretting Corrosion, Third-Body Polyethylene Damage, and Cup Positioning in Primary vs Revision Dual Mobility Total Hip Arthroplasty. J Arthroplasty 2021; 36:S80-S87. [PMID: 33610405 DOI: 10.1016/j.arth.2021.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dual mobility (DM) articulations were introduced for total hip arthroplasty to reduce the risk of instability for patients who have a high risk of dislocation. The use of DM constructs in both primary and revision total hip arthroplasty has been steadily increasing, leading to concerns regarding potential risks of fretting corrosion, polyethylene wear, metal release, and failure due to component positioning. METHODS A total of 56 retrieved DM constructs were collected. The inner and outer polyethylene liner surfaces were assessed for 7 damage mechanisms, and fretting corrosion was evaluated for the femoral stem, head, and modular liner. Three polyethylene liners with the greatest amounts of embedded debris were examined using scanning electron microscopy. Energy-dispersive X-ray spectroscopy was used to determine the elemental content of the debris. Acetabular cup orientation was analyzed radiographically using the EBRA (Einzel-Bild-Roentgen-Analyse) method. RESULTS The devices were revised most frequently for infection (36%), loosening (21%), and instability/dislocation (18%). The most common polyethylene damage mechanisms were scratching, pitting, burnishing, and embedded debris, and no difference in total damage was found between primary and revision cases. Scanning electron microscopy/energy-dispersive X-ray spectroscopy revealed that debris morphology and composition were consistent with porous titanium coating, resulting from cup loosening or broken screws and augments. A total of 71% and 50% of the constructs were determined to be within the Lewinnek safe zone for inclination and anteversion, respectively. CONCLUSION The most notable mechanisms of surface damage were due to third-body debris, especially for the polyethylene surfaces which articulate against cobalt-chromium femoral heads and acetabular liners. Scratching of the femoral head and the metal liner from this debris may support the clinical use of ceramic for DM bearing surfaces in the future.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Eric S Ouellette
- Department of Biomedical Engineering, Exponent Inc, Philadelphia, PA
| | - Olivia L Jones
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Daniel W MacDonald
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Gwo-Chin Lee
- Penn Presbyterian Medical Center, University of Pennsylvania School of Medicine, Department of Orthopaedic Surgery, Philadelphia, PA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital at Northwell Health, New York City, NY
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, NJ
| | - Steven M Kurtz
- Implant Research Core, Drexel University School of Biomedical Engineering, Science, and Health Systems, Philadelphia, PA; Department of Biomedical Engineering, Exponent Inc, Philadelphia, PA
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21
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Pai FY, Ma HH, Chou TFA, Huang TW, Huang KC, Tsai SW, Chen CF, Chen WM. Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:541. [PMID: 34126990 PMCID: PMC8204435 DOI: 10.1186/s12891-021-04404-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome. Methods We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that were conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of the most common failure modes and patient reported outcomes were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome. The study design of each study was assessed for potential bias and flaws by using the quality assessment tool for case series studies. Results A total of 119 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively. Level of evidence of this meta-analysis was IV. Conclusion Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA. Future research directions should focus on, (1) long-term outcome of modern dual-mobility design, including specific concerns such as intra-prosthetic dislocation and elevated metal ion, and (2) cost-effectiveness analysis of dual-mobility implant as an alternative to conventional THA for patients who are at high risk of dislocation. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04404-4.
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Affiliation(s)
- Fu-Yuan Pai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsan-Wen Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Chin Huang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Orthopaedic Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
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22
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French JMR, Bramley P, Scattergood S, Sandiford NA. Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:343-353. [PMID: 34150328 PMCID: PMC8183148 DOI: 10.1302/2058-5241.6.200146] [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] [Indexed: 12/29/2022] Open
Abstract
Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations.Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 - 1.8%, from 11 cohort studies containing 1312 cases).Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%.There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible.Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146.
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Affiliation(s)
- Jonathan M R French
- Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Paul Bramley
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sean Scattergood
- Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
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23
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Chan PK, Cheung SL, Lam KH, Fung WC, Chan VWK, Cheung A, Cheung MH, Fu H, Yan CH, Chiu KY. Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use. ARTHROPLASTY 2021; 3:7. [PMID: 35236462 PMCID: PMC8796556 DOI: 10.1186/s42836-020-00066-0] [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] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dual-mobility hip component is widely used in Europe and North America, because it effectively reduces hip dislocation in primary and revision total hip arthroplasties. However, reports were limited on the use of dual-mobility articulation in Asian populations. PURPOSE The aim of this retrospective study was to review the use of modular dual-mobility hip articulation in Asian patients with the high risk factor for hip dislocation. We also discussed the potential concern on the use of dual-mobility articulation in Asian patients. METHODS From Jan 2018 to June 2019, 17 patients were included in this study. The mean age of the patients was (73.8 ± 9.5) years (range: 57-88 years). The mean size of acetabular cup and modular DM liner were (49.5 ± 3.4) mm (range, 46-58 mm) and (40.7 ± 3.4) mm (range, 38-48 mm), respectively. The mean follow-up period was (15.8 ± 3.9) months (range, 11-24 months). The primary outcome was the rate of hip dislocation. The secondary outcomes included the Harris Hip Score. Differences were considered statistically significant at p < 0.05. RESULTS Hip dislocation, loosening, peri-prosthetic fractures, or intra-prosthetic dislocation was not found in the series. The mean preoperative and postoperative Harris Hip Scores were 42.2 ± 17.2 (range, 15-80) and 74.7 ± 13.5 (range, 52-97), respectively, giving a mean improvement of 32.5 ± 17.2 (range, 4-72). The improvement was statistically significant (p < 0.05). CONCLUSIONS In Asian patients with high risk of hip dislocation, the use of modular dual-mobility hip component produces promising outcomes without hip dislocation, but the relatively small-sized acetabulum may limit it widespread application in other populations worldwide. TRIAL REGISTRATION HKUCTR-2913 .
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Affiliation(s)
- Ping Keung Chan
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR.
| | - Sum Lik Cheung
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Kar Hei Lam
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Wing Chiu Fung
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Vincent Wai Kwan Chan
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Amy Cheung
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Man Hong Cheung
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Henry Fu
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Chun Hoi Yan
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
| | - Kwong Yuen Chiu
- Department of Orthopaedics & Traumatology, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, Hong Kong SAR
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Young JR, O’Connor CM, Anoushiravani AA, DiCaprio MR. The Use of Dual Mobility Implants in Patients Who Are at High Risk for Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2020; 8:e20.00028. [DOI: 10.2106/jbjs.rvw.20.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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