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Sephton BM, Havenhand T, Mace JWA. Outcomes of Dual Mobility Versus Fixed Bearing Components in Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024:S0883-5403(24)00809-X. [PMID: 39128780 DOI: 10.1016/j.arth.2024.08.005] [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: 03/16/2024] [Revised: 07/30/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024] Open
Abstract
AIMS Dual mobility (DM) implants have received increasing interest in revision surgery due to their increased stability. The aim of this systematic review was to compare outcomes of DM versus conventional fixed bearing (FB) implants in revision Total Hip Arthroplasty (r-THA). METHODS A comprehensive search was performed using the PubMed, Embase, and MEDLINE databases between January 2000 and 2023. Outcome measures included re-revision due to dislocation, re-revision for other causes, all-cause re-revision, total complication rate, and functional outcome measures. The Methodological Index for Non-Randomized Studies (MINORS) assessment tool was used to evaluate methodological quality and the risk of bias. A pooled meta-analysis was conducted, with an assessment of heterogeneity using the Chi-square and Higgins I2 tests. A further sub-group analysis was performed between DM implants and larger femoral head (> 36 mm) FB implants. RESULTS A total of 13 studies met the final inclusion criteria, with an overall number of 5,004 r-THA hips included (2,108 DM and 2,896 FB). The DM implants had significantly lower odds of re-revision due to dislocation (OR [odds ratio] 0.38, P < 0.001), aseptic loosening (OR 0.54, P = 0.004), and all-cause re-revision (OR 0.55, P < 0.001) compared to FB implants. No significant difference was seen in the odds of re-revision due to periprosthetic joint infection (PJI) (OR 0.99, P = 0.94) or periprosthetic fracture (OR 0.59, P = 0.13) between the two groups. The total number of complications showed an odds benefit in favor of DM implants (OR 0.43, P < 0.001). In the subgroup analysis, there was no significant difference in the odds of re-revision due to dislocation (OR 0.69, P = 0.11) between DM and larger femoral head FB implants. CONCLUSION Based upon current literature, it appears DM implants are an effective modality for reducing dislocation following r-THA with lower complication rates compared to FB implants. However, further prospective randomized controlled trials (RCTs) with longer term follow up are required.
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Gerber CD, Lee A, De Silva V, Yatsonsky D, Georgiadis GM. Malseated Liner in Modular Dual Mobility Total Hip Replacement: A Report of Three Cases. Cureus 2024; 16:e60437. [PMID: 38883007 PMCID: PMC11179678 DOI: 10.7759/cureus.60437] [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: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Modular dual mobility total hip arthroplasty (THA) can be associated with complications if the liner is malseated, which can be unappreciated intraoperatively. A meticulous surgical technique is needed to ensure that the liner is perfectly seated. In addition, a malseated liner can be missed if the postoperative films are not carefully reviewed by the surgeon. We present three cases of THA associated with a malseated modular dual mobility liner. In one case, the malpositioned liner was appreciated intraoperatively, but it was wedged in place and could not be removed. The entire shell needed to be revised. In two other cases, malseating was not detected intra-operatively. Both were appreciated postoperatively, and early revision surgery was needed.
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Affiliation(s)
- Caleb D Gerber
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Anderson Lee
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Vihan De Silva
- Department of Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - David Yatsonsky
- Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
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Olšovská E, Čabanová K, Motyka O, Kryštofová HB, Matějková P, Voves J, Židlík V, Madeja R, Demel J, Halfar J, Kukutschová J. Simple method for quantification of metal-based particles in biopsy samples of patients with long bone implants - Pilot study. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 103:104282. [PMID: 37769889 DOI: 10.1016/j.etap.2023.104282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
The presence of particles fixed in tissue samples due to implant degradation or disintegration plays an important role in post-operative complications. The ability to determine the size, shape, chemical composition and, above all, the number of these particles can be used in many areas of medicine. This study presents a novel, simple metal-based particle detection method using scanning electron microscopy with energy dispersive spectrometer (SEM-EDS). The presence of metal particles in biopsy specimens from long bone nail-fixated implants (10 patients with titanium steel nails and 10 patients with stainless steel nails) was studied. The samples were analysed using automated area analysis based on image binarization and brightness to 255 grayscale. The results were supplemented with histological data and statistically analysed. The method based on the software used was found to be accurate and easy to use and, thus, appears to be very suitable for particle detection in similar samples.
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Affiliation(s)
- Eva Olšovská
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic.
| | - Kristina Čabanová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Oldřich Motyka
- Nanotechnology Centre, CEET, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Hana Bielniková Kryštofová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Petra Matějková
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jiří Voves
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Vladimír Židlík
- Institute of Molecular and Clinical Pathology and Medical Genetics, University Hospital Ostrava and Faculty of Medicine, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Roman Madeja
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic
| | - Jiří Demel
- Department of Trauma Surgery, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava-Poruba 708 52, Czech Republic; Institute of Emergency, Medicine Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava 703 00, Czech Republic; Faculty of Medicine, Masaryk University, Kamenice 753/5, Brno 625 00, Czech Republic
| | - Jan Halfar
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic; Faculty of Mining and Geology, VSB-Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
| | - Jana Kukutschová
- Faculty of Material Science and Technology, Center for Advanced Innovation Technologies, VSB - Technical University of Ostrava, 17. listopadu 2172/15, Ostrava-Poruba 708 00, Czech Republic
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Dual Mobility in Total Hip Arthroplasty: Biomechanics, Indications and Complications-Current Concepts. Indian J Orthop 2021; 55:1202-1207. [PMID: 34824721 PMCID: PMC8586128 DOI: 10.1007/s43465-021-00471-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/31/2021] [Indexed: 02/04/2023]
Abstract
Dual-mobility (DM) articulations are increasingly utilized to prevent or manage hip instability after total hip arthroplasty (THA). DM cups offer enhanced stability due to the dual articulation resulting in larger jump distance and greater range of motion before impingement. Improvement in design features and biomaterials has contributed to increased interest in dual-mobility articulations due to lower risk of complications compared to their historic rates. The incidence of implant-specific complications like intra-prosthetic dislocation (IPD) and wear has reduced with newer-generation implants. DM THAs are used in primary THA in patients with high risk for dislocation, e.g. neuromuscular disorder, femoral neck fracture, spinopelvic deformity, etc. They offer an attractive alternative option to constrained liner for treatment of hip instability in revision THA. The medium- to short-term results with DM THA have been encouraging in primary and revision THA. However, there are concerns of fretting, corrosion and long-term survivorship with DM THA. Hence, longer-term studies and surveillance are required for the safe use of DM THA in clinical practice.
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