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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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Foissey C, Batailler C, Rajput V, Premkumar AB, Servien E, Lustig S. No dislocation and low complication rate for a modern dual mobility cup with pre-impacted femoral head in primary hip replacement: A consecutive series of 175 hips at minimum 5-year follow-up. SICOT J 2023; 9:1. [PMID: 36648274 PMCID: PMC9878999 DOI: 10.1051/sicotj/2022050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/26/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite its excellent results in preventing dislocation, the dual mobility cup (DMC) is still struggling to be adopted by some teams due to premature wear and loosening reported on first-generation implants. Therefore, this study aimed to assess the mid-term survivorship of a modern DMC with a pre-impacted head and the radio-clinical results at a minimum follow-up of 5 years. METHODS This was a retrospective single-centre study performed on patients who had a primary total hip replacement for osteoarthritis in 2016. The cup was a third-generation DMC with a pre-impacted femoral head. Clinical (harris hip score (HHS)) and radiological (cup abduction, anteversion, overhang, and radiolucent lines) results were recorded, as well as complications, particularly dislocations and survivorship. A minimum of five years of follow-ups was required. RESULTS One hundred and seventy-five hips (167 patients) met the inclusion criteria. Five hips (2.9%, 5/175) were lost to follow-up and excluded from the postoperative analysis. The mean follow-up period was 70 ± 2.9 months [63.6-76.5]. Three cups needed revision surgery (1.8%, 3/170): one for septic loosening, and two for chronic infection. At 77 months, the global survival probability was 98.2% ± 1, and the survival probability excluding septic aetiology was 100%. There was a significant improvement in the HHS from pre-operatively (48.3 ± 6.0 [14.0-70.0]) to post-operatively (96 ± 4.5 [50-100]) (p < 0.0001). There were no postoperative dislocations recorded, nor any iliopsoas-impingement or symptomatic cam-effect. DISCUSSION This study showed excellent survival and good radiological and clinical results of this dual mobility cup at a mid-term follow-up. None of the patients had dislocation or any specific complication feared with dual mobility cups.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France,Corresponding author:
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1 69100 Lyon France
| | - Vishal Rajput
- The Midyorkshire Hospitals NHS Trust WF14DG Wakefield United Kingdom
| | | | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1 69100 Lyon France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence 69004 Lyon France,Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
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Ciolli G, Mesnard G, Deroche E, Gunst S, Batailler C, Servien E, Lustig S. Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review. J Pers Med 2022; 13:jpm13010081. [PMID: 36675742 PMCID: PMC9867154 DOI: 10.3390/jpm13010081] [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] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Gianluca Ciolli
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Sacred Heart Catholic University, 00168 Rome, Italy
| | - Guillaume Mesnard
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Correspondence:
| | - Etienne Deroche
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
| | - Stanislas Gunst
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- LIBM—EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University, 69622 Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France
- Univ Lyon, Claude Bernard Lyon 1 University, IFST-TAR, LBMC UMR_T9406, 69622 Lyon, France
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Gaillard T, Ramos-Pascual S, Saffarini M, Piton JP. The Saturne cementless dual-mobility cup grants satisfactory long-term survival. J Exp Orthop 2022; 9:105. [PMID: 36219317 PMCID: PMC9552733 DOI: 10.1186/s40634-022-00542-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To report long-term survival and clinical outcomes of primary total hip arthroplasty (THA) using a Saturne cementless dual-mobility (DM) cup, and investigate whether patient demographics or surgical parameters affect clinical scores. Methods A consecutive series of primary THAs implanted with Saturne cementless DM cups between 01/09/2009–31/12/ 2011 was retrospectively assessed. Patients were postoperatively evaluated using modified Harris hip score (mHHS) and forgotten joint score (FJS). Complications, reoperations, and revisions were noted. Regression analyses were performed to determine associations of postoperative mHHS with preoperative and intraoperative variables. Ten-year Kaplan–Meier survival was calculated. Results Of 308 patients (308 hips), 111 (36%) had died with their original cups in place, 29 (9%) were lost-to-follow-up, and 5 (2%) required cup revision, leaving a final cohort of 163 (53%) with their original cup in place at a follow-up of ≥ 10 years. Ten-year survival was 98% considering cup revision for any reason as endpoint; 99% considering cup revision for aseptic loosening as endpoint; 96% considering stem revision for any reason as endpoint; and 96% considering any revision as endpoint. The final cohort of 163 patients was assessed at 11 ± 1 years (range, 10–13), mHHS was 85 ± 16 (range, 31–100) and FJS was 84 ± 24 (range, 0–100). Multivariable regression analysis revealed that postoperative mHHS significantly worsened with age (β = -0.48, p = 0.007) and BMI (β = -0.70, p = 0.008), as well as for 22 mm head sizes (β = -6.98, p = 0.046). Conclusions The Saturne DM cup granted satisfactory survival and clinical outcomes at a minimum follow-up of 10 years, and resulted in no cases of intra- or extra-prosthetic dislocations.
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Affiliation(s)
- Thierry Gaillard
- Polyclinique du Beaujolais, 120 Anc. Rte de Beaujeu, 69400, Arnas, France
| | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
| | - Jean-Pierre Piton
- UNEOS - Hôpitaux Privés de Metz, 15 Rue de Sarre, 57070, Metz, France
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Schneider L, Châtain F, Estour G, Ramos-Pascual S, Nover L, Bonin N. Total Hip Arthroplasty Using a Hemispherical Uncemented Dual-Mobility Cup Results in Satisfactory Clinical Outcomes and No Dislocations at 2 years. Arthroplast Today 2021; 9:93-97. [PMID: 34136611 PMCID: PMC8181579 DOI: 10.1016/j.artd.2021.04.017] [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: 11/12/2020] [Revised: 03/19/2021] [Accepted: 04/27/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The authors performed total hip arthroplasty (THA) using a novel hemispherical dual-mobility (DM) acetabular cup without a protrusive cylindro-spherical rim, intended to reduce risks of iliopsoas impingement without requiring changes to conventional intraoperative positioning as with unipolar cups. We aim to determine clinical scores and rates of dislocations, complications, and revisions of this hemispherical DM cup, with the hypothesis that this novel design would result in clinical scores and dislocation rates comparable to other contemporary DM cups with protrusive cylindro-spherical rims. METHODS We assessed 332 consecutive uncemented THAs performed using a hemispherical DM cup, at a minimum 2-year follow-up, using modified Harris Hip Score (mHHS) and Oxford Hip Score (OHS), and noting complications and revisions. Regression analyses were conducted to determine if mHHS and OHS depended on any independent factors. RESULTS At 2.8 ± 0.5 years (range, 2-5), 2 patients (0.6%) had stem and cup revisions, 3 patients (1%) had isolated stem revisions, 13 patients (4%) died, and none were lost to follow-up. No dislocations occurred. For the final cohort of 305 patients (314 hips) with their original implants in place, mHHS was 92 ± 12 (range, 46-100), and OHS was 57 ± 5 (range, 34-60). Multivariable analyses revealed that mHHS and OHS decreased significantly with age (β = -0.35, P < .001, and β = -0.15, P < .001, respectively). CONCLUSIONS With no dislocations and satisfactory clinical scores, this sizable cohort confirms that the novel hemispherical DM cup studied is effective at preventing dislocations, although longer-term follow-up remains necessary to ascertain the longevity of clinical outcomes and radiographic stability. LEVEL OF EVIDENCE Level IV, multicentric retrospective case series.
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Affiliation(s)
| | | | | | | | | | - Nicolas Bonin
- Ramsay Santé, Clinique de la Sauvegarde, Lyon-Ortho-Clinic, France
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