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A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants. J Arthroplasty 2022; 38:957-969.e1. [PMID: 36481281 DOI: 10.1016/j.arth.2022.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with constrained acetabular components and dual mobility implants in rTHA. METHODS Longitudinal studies reporting dislocation after the use of constrained acetabular components or dual mobility implants in rTHA were sought from Medline and Embase to October 2022. Secondary outcomes included re-revision surgery for dislocation and all causes. A total of 75 relevant citations were identified comprising 36 datasets of 3,784 constrained acetabular components and 47 datasets of 10,216 dual mobility implants. RESULTS For constrained acetabular components, the pooled incidence of dislocation was 9% (95% confidence interval: 7.2, 11.7) (range 0.0%-35.3%) over a weighted mean follow-up of 6 years, in contrast to 3% (95% confidence interval: 2.2, 4.4) (range 0.0%-21.4%) over 5 years for dual mobility implants. Re-revision rates for dislocation after using constrained acetabular components were around 9%, in contrast to 2% for dual mobility implants. Re-revision rates for all causes after using constrained acetabular components were around 19%, in contrast to 8% for dual mobility implants. CONCLUSION Dual mobility implants in the context of rTHA demonstrate lower incidences of dislocation (3% versus 9%), re-revision for dislocation (2% versus 9%), and rer-evision for any cause (8% versus 19%) in contrast to constrained acetabular components. This must be considered by surgeons when implanting such devices, often selected to treat instability.
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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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Giacomo P, Giulia B, Valerio P, Vincenzo S, Pierluigi A. Dual mobility for total hip arthroplasty revision surgery: A systematic review and metanalysis. SICOT J 2021; 7:18. [PMID: 33749588 PMCID: PMC7984151 DOI: 10.1051/sicotj/2021015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/27/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Revision THA (R-THA) is thought to have a higher complication rate if compared to primary THA. Dual Mobility (DM) implants have been designed aiming for achieving greater stability, with good clinical results. However, scarce material can be found about the real improvements provided by this type of implant compared to traditional implant in Revisions of Total Hip Arthroplasties. METHODS A systematic review and meta-analysis of comparative studies were performed in December 2019. This was in accordance with the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Our primary outcome measure was overall survivorship and dislocation rate, either treated with a conservative method or requiring surgery. RESULTS Regarding the overall implant survival, we found a slight significant risk ratio, with a statistically meaningful difference between the two groups in questions in favour of the DM implant. A statistically significant difference in favour of the DM group turned out considering only the Dislocation rate Risk ratio and the aseptic loosening risk as well. No statistical difference was found between the two groups about the risk ratio of infection. DISCUSSION A steady increase of evidence is demonstrating the efficacy of using a DM cup system in THA revisions with low dislocation rates, but currently there is no study in the literature that demonstrates with statistically significant evidence. The main finding of the present study is that implant's Survivor and prevention of dislocation at medium follow-up showed better results with a DM if compared to a fixed-bearing cup, for Revision THA.
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Affiliation(s)
- Placella Giacomo
- Hospital San Raffaele - Orthopaedic Department, Milan 20132, Italy
| | | | - Pace Valerio
- Università degli Studi di Perugia, Perugia 06123, Italy
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Klemt C, Smith EJ, Oganesyan R, Limmahakhun S, Fitz D, Kwon YM. Outcome of Dual Mobility Constructs for Adverse Local Tissue Reaction Associated Abductor Deficiency in Revision Total Hip Arthroplasty. J Arthroplasty 2020; 35:3686-3691. [PMID: 32654942 DOI: 10.1016/j.arth.2020.06.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Treatment of adverse local tissue reaction (ALTR) is challenging owing to high complications and poor outcomes after a revision surgery. As dislocation is the most common cause of reoperation, it is often necessary to use advanced articulations such as dual mobility. This study aims to evaluate the outcome and complication rates after revision surgery with dual mobility constructs, compared to constrained and conventional articulations in the setting of significant abductor deficiency due to ALTR. METHODS Out of a total of 338 revision total hip arthroplasties for ALTR, 234 patients with a significant tissue necrosis and abductor muscle insufficiency (grade 3) were evaluated. The complication rates after revisions were compared between 42 hips with dual mobility implants, 24 hips with constrained liners, 104 hips with large diameter heads (36-40 mm), and 64 hips with small diameter heads (≤32 mm). RESULTS After an average of 4 years of follow-up (2.8-8.6), the dual mobility articulation had no dislocation, compared to 4.1% and 15.5% for constrained liner and conventional articulations, respectively (P < .001). Utilization of dual mobility and constrained liner cup also did not increase the risk of nondislocation complications, including periprosthetic joint infection and periprosthetic fracture (P = .18 and .52). CONCLUSIONS This study demonstrates significantly lower dislocation rates for dual mobility when compared to conventional articulations and comparable to constrained liners in cases of severe abductor deficiency due to ALTR, suggesting that dual mobility implants are viable surgical treatment alternatives to constrained liners to minimize dislocation during revision total hip arthroplasty in the setting of significant abductor deficiency due to ALTR.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Fitz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Van Eecke E, Vanbiervliet J, Dauwe J, Mulier M. Comparison of Constrained Acetabular Components and Dual Mobility Cups in Revision Total Hip Arthroplasty: A Literature Review. Hip Pelvis 2020; 32:59-69. [PMID: 32566536 PMCID: PMC7295616 DOI: 10.5371/hp.2020.32.2.59] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/10/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022] Open
Abstract
Recurrent instability remains a common cause of failure after revision total hip arthroplasty (THA). Dual mobility (DM) cups and designs with constrained acetabular liners (CAL) have both been developed to help overcome this challenge. The aim of this report is to compare safety and efficacy outcomes of both designs based on the literature. A comprehensive literature review including published evidence on the results of DM and CAL in revision THA was performed and summarized. Available literature focusing on overall survival, dislocation, loosening, intra-prosthetic dislocation (IPD), and functional outcomes were analysed. Forty-six reports including an evaluation of 5,617 total hips were evaluated were included in the review. The included studies were divided into two distinct groups based on implantation approach: i) CAL (n=15) and ii) DM (n=31). The DM group had higher overall survival rates (94.7% vs. 81.0%), lower dislocation rates (2.6% vs. 11.0%), and lower acetabular loosening rates (1.0% vs. 2.0%) compared to the CAL group. IPDs were reported in 6 studies (mean rate, 0.6%). No differences in functional outcomes were identified due to incomplete reports. Our observations reveal that designs with CAL have poorer outcomes as compared to DM cups in revision THA. Currently, the use of DM seems more appropriate since they offer lower rates of dislocations, loosening and re-revisions in the short- and mid-term. Concerns regarding the potential of increased wear in a younger, high-demand population require additional data and evaluation by long-term studies for the DM design.
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Affiliation(s)
- Eduard Van Eecke
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jens Vanbiervliet
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Dauwe
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michiel Mulier
- Department of Orthopedic Surgery, University Hospitals Leuven, Leuven, Belgium
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de l'Escalopier N, Dumaine V, Auberger G, Babinet A, Courpied JP, Anract P, Hamadouche M. Dual mobility constructs in revision total hip arthroplasty: survivorship analysis in recurrent dislocation versus other indications at three to twelve-year follow-up. INTERNATIONAL ORTHOPAEDICS 2019; 44:253-260. [PMID: 31758218 DOI: 10.1007/s00264-019-04445-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate the clinical, radiologic, and survival results of dual mobility (DM) sockets in revision total hip arthroplasty (THA) performed for instability versus revision THAs performed for other reasons. METHODS From a computerized database, we identified 84 revision THAs using a modern DM socket performed in 81 patients with a mean age of 71 years. Indication for revision was recurrent dislocation in 47 hips, and other reasons in the remaining 37 hips. A survivorship analysis according to the actuarial method was carried out on the entire series using revision for any cause, revision for dislocation, and radiological cup loosening revised or not, as the end points. RESULTS Of the 81 patients, twelve died, six were lost to follow-up, eight had been revised, and 55 patients (58 hips) were unrevised and alive at a mean follow-up of 6.4 years. Dislocation occurred in four of the 47 (8.5%) hips for which indication for revision was dislocation versus one of the remaining 37 (2.7%) hips [odds ratio = 3.4 (0.4-31.3), p = 0.07]. According to our criteria, three acetabular components of which one was revised were considered as loosened. When using revision for dislocation as the end-point, the survival rate at seven years was 90.4 ± 5.3% (IC95%, 79.9-100) in the 47 hips for which the indication for revision was dislocation versus 100% in the remaining 37 hips (log-rank, p = 0.5). CONCLUSIONS The current study indicated that DM sockets represent an interesting solution to prevent dislocation in revision THAs at mid-term follow-up.
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Affiliation(s)
- Nicolas de l'Escalopier
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
| | - Valérie Dumaine
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Guillaume Auberger
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Antoine Babinet
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Jean-Pierre Courpied
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Philippe Anract
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Moussa Hamadouche
- Clinical Orthopaedics Research Center, Department of Orthopaedic and Reconstructive Surgery, Hôpitaux Universitaires Paris Centre (HUPC), Site Cochin-Port Royal, Assitance Publique-Hôpitaux de Paris (AP-HP), Université Paris 5, 27 Rue du Faubourg St Jacques, 75014, Paris, France
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Huten D, Fournier Y, Gicquel T, Bertho P, Basselot F, Hamadouche M. Risk factors for dislocation after revision total hip arthroplasty with a dual-mobility cup. Matched case-control study (16 cases vs. 48 controls). Orthop Traumatol Surg Res 2019; 105:1303-1309. [PMID: 31153859 DOI: 10.1016/j.otsr.2019.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reports of high dislocation rates after revision total hip arthroplasty (THA) have encouraged the widespread use of dual-mobility cups. Dislocation has been less common but not fully abolished with dual-mobility cups, and its causes have remained unidentified. The objectives of this retrospective matched case-control study were: 1) to identify risk factors for dislocation, 2) and to assess dislocation outcomes. HYPOTHESIS The causes of dislocation after revision THA with a dual-mobility cup can be identified. MATERIAL AND METHOD Among 653 consecutive patients identified retrospectively as having undergone revision THA with a dual-mobility cup (Medial Cup, Aston, Saint-Étienne, France) between January 2007 and December 2017, 16 (2.45%) subsequently experienced dislocation, after a mean of 3.6 months (range, 0.9-19 months). For each of these 16 patients, we collected the main patient characteristics (age, sex, body mass index [BMI], ASA score, and reason for the initial arthroplasty procedure), local history (number of previous surgical procedures, reason for revision, femoral and acetabular bony defects classified according to Paprosky, and status of the abductor apparatus), and characteristics of the revision (approach, diameters of the cup and femoral head, cup inclination, femoral offset, lower limb length, and implant anteversion). Controls were patients without dislocation after revision dual-mobility THA. Each of the 16 patients was matched to 3 controls on age (±10 years), sex, year of revision, and whether revision was only acetabular or bipolar. Univariate and multivariate analyses were done to compare the cases and controls, and dislocation outcomes in the cases were evaluated. RESULTS By univariate analyses, factors associated with dislocation were BMI>30 (cases, 37.5%; controls, 10.4%; p=0.02), larger number of previous surgical procedures on the same hip (cases, 2.8; controls, 1.8; p=0.004), larger number of arthroplasties (cases, 2.3; controls, 1.5; p=0.004), history of instability (cases, 31% with chronic dislocation and 13% with recurrent dislocation; controls, 6.25% and 2.1%, respectively; p=0.004), and compromised abductor apparatus (cases, 56.25%; controls, 14.6%; p=0.002). Independent risk factors for dislocation identified by multivariate analysis were instability (odds ratio [OR], 14.5; 95% confidence interval [95%CI], 1.5-149.9) and, most importantly, abductor apparatus compromise (OR, 43.1; 95%CI, 3.18-586.3). Of the 16 cases, 1 was lost to follow-up, 1 had contra-indications to anaesthesia, 1 died after several dislocation episodes, and 1 died 3 months after surgical reduction. In 5 cases, there was a single dislocation episode. Further surgery was performed in 8 cases (surgical reduction, n=1; constrained cup, n=3; trochanteric internal fixation, n=1; exchange of the dual-mobility cup, n=2, including 1 with subsequent dislocation episodes; and femoral component exchange followed by a retentive cup due to further dislocation episodes, n=1). CONCLUSION Risk factors for dislocation consisted of a history of instability and, most importantly, abductor apparatus compromise. A constrained cup should be considererd in patients with impaired abductor apparatus. No further dislocations occurred after reduction of the first episode in 31.25% of cases. Recurrent dislocation should prompt measures to correct impaired abductor apparatus whenever possible, as well as correction of any component malposition. Whether a retentive cup should be implanted routinely remains unclear. LEVEL OF EVIDENCE III, matched case-control study.
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Affiliation(s)
- Denis Huten
- Service de chirurgie orthopédique et réparatrice de l'appareil moteur du CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - Yohann Fournier
- Service de chirurgie orthopédique et réparatrice de l'appareil moteur du CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Thomas Gicquel
- Service de chirurgie orthopédique et réparatrice de l'appareil moteur du CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Pierre Bertho
- Service de chirurgie orthopédique et réparatrice de l'appareil moteur du CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Frédéric Basselot
- Service de chirurgie orthopédique et réparatrice de l'appareil moteur du CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Moussa Hamadouche
- Service d'orthopédie de l'hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
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Huang RC, Malkani AL, Harwin SF, Hozack WJ, Mont MA, Higuera-Rueda CA, Westrich GH. Multicenter Evaluation of a Modular Dual Mobility Construct for Revision Total Hip Arthroplasty. J Arthroplasty 2019; 34:S287-S291. [PMID: 31005430 DOI: 10.1016/j.arth.2019.03.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Modular Dual Mobility (MDM) constructs in total hip arthroplasty (THA) offer increased hip stability compared with constrained liners, without compromising hip range of motion. The purpose of this study was to evaluate outcomes of revision THA using MDM. METHODS The study was a multiinstitutional retrospective cohort study of 315 hips that underwent revision THA using MDM between 2011 and 2017. Clinical outcomes and reasons for failure were collected. RESULTS Three hundred fifteen patients met 1-year minimum follow-up (mean 3.3 years). Nine hips had instability postoperatively (2.9%), and 30 hips required reoperation (9.5%). Seven had recurrent instability (6.5%) which was associated with liner-only exchange (P = .021) and liner outer diameter of ≤ 38 mm (P = .016). CONCLUSION Revision THA with MDM provided a low rate of instability and reoperation in a revision cohort. Recurrent instability following use of MDM in revision THA was associated with retention of the acetabular component and polyethylene outer diameter ≤ 38 mm. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Ronald C Huang
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY; Department of Orthopedic Surgery, BronxCare Health Systems, Bronx, NY
| | | | - Steven F Harwin
- Department of Orthopedics, Mt. Sinai West Hospital, New York, NY
| | | | - Michael A Mont
- Department of Orthopedics, Cleveland Clinic, Cleveland, OH; Department of Orthopaedic Surgery, Lenox Hill at Northwell, New York, NY
| | | | - Geoffrey H Westrich
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
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Neri T, Philippot R, Klasan A, Putnis S, Leie M, Boyer B, Farizon F. Dual mobility acetabular cups for total hip arthroplasty: advantages and drawbacks. Expert Rev Med Devices 2018; 15:835-845. [PMID: 30345834 DOI: 10.1080/17434440.2018.1538781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The dual mobility cup (DMC) concept was proposed by Professor Gilles Bousquet in 1974. Its' aims were to prevent postoperative dislocation, restore the physiological range of motion of the hip, and reduce the stresses at the interface. Since it was created, this design has been modified multiple times to reduce the complication rate, improve implant survival, and expand the indications. AREAS COVERED The objective of this review is to discuss the advantages and disadvantages of this implant based on its 40-year history and also to propose a range of indications based on published results. This will provide surgeons with a complete overview of DMC. EXPERT COMMENTARY Published studies on DMC confirm the low dislocation rate. Improvements made to DMC overtime have greatly reduced the complications related to wear, such as aseptic loosening and intraprosthetic dislocation (IPD). According to the literature, the indications have expanded and are no longer limited to revision surgery only. Long-term studies are needed before we can draw formal conclusions and consolidate these promising results.
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Affiliation(s)
- Thomas Neri
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France.,c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Remi Philippot
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Antonio Klasan
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Sven Putnis
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Murilo Leie
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Bertrand Boyer
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Frederic Farizon
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
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Harwin SF, Sultan AA, Khlopas A, Chughtai M, Sodhi N, Piuzzi NS, Mont MA. Mid-Term Outcomes of Dual Mobility Acetabular Cups for Revision Total Hip Arthroplasty. J Arthroplasty 2018; 33:1494-1500. [PMID: 29307678 DOI: 10.1016/j.arth.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study evaluated (1) survivorship, (2) clinical outcomes, (3) complications, and (4) radiographic outcomes of dual mobility (DM) systems when compared to fixed-bearing prostheses in revision total hip arthroplasty (THA). METHODS A cohort of 85 patients who underwent revision THA using DM implants were compared to a prior matching cohort of 170 patients who received fixed-bearing implants. Mean follow-up time was 4 years in the DM cohort and 10 years in the fixed-bearing cohort. Kaplan-Meier analysis was performed to assess survivorships. Clinical outcomes were evaluated using the Harris Hip Score (HHS). Complications and radiographs were evaluated and reported at the final follow-up. RESULTS Overall aseptic and all-cause survivorships of the DM cohort were 96.5% and 95.3% compared to 94.7% and 93.5% in fixed-bearing cohort (P = .01 for aseptic and all-cause survivorships). The DM cohort had statistically significant higher survivorship when compared at equivalent follow-up interval in the fixed-bearing cohort. There were 3 aseptic (one due to dislocation) and 1 septic revision in the DM cohort compared to 9 aseptic (6 due to dislocation) and 2 septic revisions in the fixed-bearing cohort. Postoperative HHS scores were 88 and 86 points in the DM and fixed-bearing cohorts. However, the difference in mean improvement in HHS scores from preoperative to postoperative (ΔHHS) was not statistically significant (35 vs 34, P = .533). Except for the aforementioned revisions, there were no progressive radiolucencies or osteolysis on radiographic evaluation in both cohorts. CONCLUSION DM articulations demonstrated superior survivorship at equal follow-up intervals when compared to fixed-bearing implants and showed a trend toward lower dislocation rates.
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Affiliation(s)
- Steven F Harwin
- Department of Advanced Technology of Total Hip and Knee Arthroplasty, Mount Sinai West Hospital, New York, NY
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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11
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Lange JK, Spiro SK, Westrich GH. Utilizing Dual Mobility Components for First-Time Revision Total Hip Arthroplasty for Instability. J Arthroplasty 2018; 33:505-509. [PMID: 29079169 DOI: 10.1016/j.arth.2017.09.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Dislocation following total hip arthroplasty (THA) remains a significant clinical problem. Few studies have focused on the use of dual mobility (DM) components in the setting of first-time revision for instability following THA. Here, we investigate patient outcomes following first-time revision THA with DM components for a diagnosis of instability. METHODS Institution-wide revision THAs using DM components performed between 2010 and 2013 were identified. Chart review identified 40 patients with average 3-year follow-up who had undergone first-time revision for instability, defined as instability after primary THA. Etiology of instability was classified by Wera type. Patient demographics, medical co-morbidities, re-dislocations, and re-revisions were recorded. Component position and leg-length discrepancy were measured on pre-operative and post-operative radiographs when available. Utilizing Student's t-test or Fisher's exact test, we analyzed differences between those who endured recurrent dislocation and those who did not. RESULTS Recurrent dislocation occurred in 2 patients (5%). Both patients underwent re-revision for recurrent instability and carried diagnoses of instability of unresolved etiology. Two patients underwent re-revision for reasons unrelated to the DM construct. All-cause re-revision rate at final follow-up was therefore 10% (4 patients). No medical, demographic, or radiographic factors were significantly associated with risk of recurrent instability (P > .05). CONCLUSION The use of DM components for first-time revision THA for a diagnosis of instability carried a re-dislocation rate of 5% and an all-cause re-revision rate of 10% at average 3-year follow-up. Instability of unresolved etiology was associated with re-dislocation following revision surgery.
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Affiliation(s)
- Jeffrey K Lange
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara K Spiro
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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12
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Abstract
Aims Instability remains a challenging problem in both primary and revision total hip arthroplasty (THA). Dual mobility components confer increased stability, but there are concerns about the unique complications associated with these designs, as well as the long-term survivorship. Materials and Methods We performed a systematic review of all English language articles dealing with dual mobility THAs published between 2007 and 2016 in the MEDLINE and Embase electronic databases. A total of 54 articles met inclusion criteria for the final analysis of primary and revision dual mobility THAs and dual mobility THAs used in the treatment of fractures of the femoral neck. We analysed the survivorship and rates of aseptic loosening and of intraprosthetic and extra-articular dislocation. Results For the 10 783 primary dual mobility THAs, the incidence of aseptic loosening was 1.3% (142 hips); the rate of intraprosthetic dislocation was 1.1% (122 hips) and the incidence of extra-articular dislocation was 0.46% (41 hips). The overall survivorship of the acetabular component and the dual mobility components was 98.0%, with all-cause revision as the endpoint at a mean follow-up of 8.5 years (2 to 16.5). For the 3008 revision dual mobility THAs, the rate of aseptic acetabular loosening was 1.4% (29 hips); the rate of intraprosthetic dislocation was 0.3% (eight hips) and the rate of extra-articular dislocation was 2.2% (67 hips). The survivorship of the acatabular and dual mobility components was 96.6% at a mean of 5.4 years (2 to 8). For the 554 dual mobility THAs which were undertaken in patients with a fracture of the femoral neck, the rate of intraprosthetic dislocation was 0.18% (one hip), the rate of extra-articular dislocation was 2.3% (13 hips) and there was one aseptic loosening. The survivorship was 97.8% at a mean of 1.3 years (0.75 to 2). Conclusion Dual mobility articulations are a viable alternative to traditional bearing surfaces, with low rates of instability and good overall survivorship in primary and revision THAs, and in those undertaken in patients with a fracture of the femoral neck. The incidence of intraprosthetic dislocation is low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to evaluate further the use of dual mobility components in THA. Cite this article: Bone Joint J 2018;100-B:11–19.
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Affiliation(s)
- B. Darrith
- Rush University Medical Center, 1611
W. Harrison St, Suite 300, Chicago, Illinois 60612, USA
| | - P. M. Courtney
- Rothman Institute, Thomas Jefferson University
Hospital, 925 Chestnut St., Phildelphia, 19107, USA
| | - C. J. Della Valle
- Rush University Medical Center, 1611
W. Harrison St, Suite 300, Chicago, Illinois 60612, USA
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13
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De Martino I, D'Apolito R, Waddell BS, McLawhorn AS, Sculco PK, Sculco TP. Early intraprosthetic dislocation in dual-mobility implants: a systematic review. Arthroplast Today 2017; 3:197-202. [PMID: 28913407 PMCID: PMC5585769 DOI: 10.1016/j.artd.2016.12.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Dual mobility implants are subject to a specific implant-related complication, intraprosthetic dislocation (IPD), in which the polyethylene liner dissociates from the femoral head. For older generation designs, IPD was attributable to late polyethylene wear and subsequent failure of the head capture mechanism. However, early IPDs have been reportedly affecting contemporary designs. METHODS A systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar was conducted for English articles between January 1974 and August 2016 using various combinations of the keywords "intraprosthetic dislocation," "dual mobility," "dual-mobility," "tripolar," "double mobility," "double-mobility," "hip," "cup," "socket," and "dislocation." RESULTS In all, 16 articles met our inclusion criteria. Fourteen were case reports and 2 were retrospective case series. These included a total of 19 total hip arthroplasties, which were divided into 2 groups: studies dealing with early IPD after attempted closed reduction and those dealing with early IPD with no history of previous attempted closed reduction. Early IPD was reported in 15 patients after a mean follow-up of 3.2 months (2.9 SD) in the first group and in 4 patients after a mean follow-up of 15.1 months (9.9 SD) in the second group. CONCLUSIONS Based on the current data, most cases have been preceded by an attempted closed reduction in the setting of outer, large articulation dislocation, perhaps indicating an iatrogenic etiology for early IPD. Recognition of this possible failure mode is essential to its prevention and treatment.
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Affiliation(s)
- Ivan De Martino
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Rocco D'Apolito
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Bradford S. Waddell
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Alexander S. McLawhorn
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Peter K. Sculco
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA
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14
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Abstract
Dislocation remains a common cause of failure after total hip arthroplasty. The limitations of existing approaches to address instability have led to the development of powerfull options: constrained liners, dual mobility and large heads. These implant-related options have proven to be very efficient, but have raised concerns.With constrained liners, restricted range of motion (ROM) is responsible for impingement leading to high likelihood of failure, depending on the design, with various failure modes.Improvements of the bearing materials have addressed some of the concerns about increased volumetric wear of conventional polyethylene and offer an option to reduce instability: large diameter heads have the advantage of increased ROM before impingement, increased head-neck ratio, and jump distance. Highly cross-linked polyethylene helps address the risk for increased wear, and also large heads provide improved stability without the risk of mechanical failures observed with constrained liners. However, the increase of the head size remains limited as reducing the thickness of the liner may lead to fractures. In addition, the jump distance decreases as the cup abduction increases.The dual mobility concept simultaneously attempts to address head-neck ratio, constraint, and jump distance. Despite the need for longer follow-up, concerns raised about potential increased wear and intra-prosthetic dislocation with first generation implants have been addressed with modern designs.With a dramatic increase of the head-neck ratio whilst reducing the risk of mechanical failure or excessive wear, dual mobility THA outperforms large diameter heads and constrained liners at 10 years follow-up. For these reasons, dual mobility continues to gain interest worldwide and is becoming the most popular option to manage instability. Cite this article: Guyen O. Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA. EFORT Open Rev 2016;1:197-204. DOI: 10.1302/2058-5241.1.000054.
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Affiliation(s)
- Olivier Guyen
- Department of Orthopaedic Surgery, Lausanne University Hospital, Lausanne, Switzerland
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15
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De Martino I, D'Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J 2017; 99-B:18-24. [PMID: 28042114 DOI: 10.1302/0301-620x.99b1.bjj-2016-0398.r1] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/05/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this systematic review was to report the rate of dislocation following the use of dual mobility (DM) acetabular components in primary and revision total hip arthroplasty (THA). MATERIALS AND METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. A comprehensive search of Pubmed/Medline, Cochrane Library and Embase (Scopus) was conducted for English articles between January 1974 and March 2016 using various combinations of the keywords "dual mobility", "dual-mobility", "tripolar", "double-mobility", "double mobility", "hip", "cup", "socket". The following data were extracted by two investigators independently: demographics, whether the operation was a primary or revision THA, length of follow-up, the design of the components, diameter of the femoral head, and type of fixation of the acetabular component. RESULTS In all, 59 articles met our inclusion criteria. These included a total of 17 908 THAs which were divided into two groups: studies dealing with DM components in primary THA and those dealing with these components in revision THA. The mean rate of dislocation was 0.9% in the primary THA group, and 3.0% in the revision THA group. The mean rate of intraprosthetic dislocation was 0.7% in primary and 1.3% in revision THAs. CONCLUSION Based on the current data, the use of DM acetabular components are effective in minimising the risk of instability after both primary and revision THA. This benefit must be balanced against continuing concerns about the additional modularity, and the new mode of failure of intraprosthetic dislocation. Longer term studies are needed to assess the function of these newer materials compared with previous generations. Cite this article: Bone Joint J 2017;99-B(1 Supple A):18-24.
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Affiliation(s)
- I De Martino
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - R D'Apolito
- Catholic University of the Sacred Heart, Agostino Gemelli University Hospital, Largo Agostino Gemelli 8, Rome, 00168, Italy
| | - V G Soranoglou
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - L A Poultsides
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - P K Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - T P Sculco
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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16
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Mohaddes M, Cnudde P, Rolfson O, Wall A, Kärrholm J. Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. INTERNATIONAL ORTHOPAEDICS 2017; 41:583-588. [DOI: 10.1007/s00264-016-3381-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/19/2016] [Indexed: 01/26/2023]
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17
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Batailler C, Fary C, Verdier R, Aslanian T, Caton J, Lustig S. The evolution of outcomes and indications for the dual-mobility cup: a systematic review. INTERNATIONAL ORTHOPAEDICS 2016; 41:645-659. [PMID: 28004142 DOI: 10.1007/s00264-016-3377-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/11/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE Instability following total hip arthroplasty remains a common and disabling complication. The dual mobility cup (DMC) allows a reduction in the dislocation rate. An increasing number of studies have been undertaken to better understand DMC long term outcomes and complications. The goal of this systematic review was to clarify its different uses and outcomes according to the indications. METHODS A comprehensive literature review was performed using the keywords 'dual mobility' and 'tripolar cup' with no limit regarding the year of publication. One hundred seventy six publications were identified. RESULTS Current literature shows that "contemporary" dual mobility cup are a significant indication to manage instability following primary and revision hip arthroplasty. Survivorship at midterm is comparable to other articulations for primary THA, but is more difficult to evaluate in revision. Intra-prosthetic dislocation, wear, and loosening are now uncommon with new generations of DMC. CONCLUSIONS Compared to previous generations of DMC, the current "contemporary" DMC presents a significant improvement. Current literature reveals a tendency to increase the indications but further studies with long term follow up remain important to consolidate these findings.
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18
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Dual mobility cups in revision total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2016; 41:535-542. [DOI: 10.1007/s00264-016-3363-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023]
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19
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Hamadouche M, Ropars M, Rodaix C, Musset T, Gaucher F, Biau D, Courpied JP, Huten D. Five to thirteen year results of a cemented dual mobility socket to treat recurrent dislocation. INTERNATIONAL ORTHOPAEDICS 2016; 41:513-519. [PMID: 27889840 DOI: 10.1007/s00264-016-3343-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/08/2016] [Indexed: 01/23/2023]
Abstract
PURPOSE Dual mobility (DM) socket has been associated with a low rate of dislocation following both primary and revision total hip arthroplasty (THA). However, little is known about the long-term efficiency of DM in the treatment of THA instability. The purpose of this retrospective study was to evaluate the outcome of a cemented DM socket to treat recurrent dislocation after a minimum of five year follow-up. METHODS The series included 51 patients with a mean age of 71.3 ± 11.5 (range, 41-98) years presenting with recurrent dislocation (mean 3.3). A single DM socket design was used consisting of a stainless steel outer shell with grooves with a highly polished inner surface articulating with a mobile polyethylene component. The femoral head was captured in the polyethylene component using a snap-fit type mechanism, the latter acting as a large unconstrained head inside the metal cup. RESULTS At the minimum five year follow-up evaluation, 18 of the 51 patients deceased at a mean of 4.8 ± 2.3 years, three were lost to follow-up at a mean of 1.4 years, seven had been revised at a mean of 4.7 ± 3.1 years (range, 1.5-9.1), and the remaining 23 were still alive and did not have revision at a mean of 8.2 ± 2.4 years (range, 5-13 years). Of the seven revision, three were performed for further episodes of dislocation (at the large bearing for one patient and intra-prosthetic for two patients) after a mean 5.9 ± 2.9 years (range, 2.7-9.1), whereas two were performed for late sepsis and two for aseptic loosening of the acetabular component. Radiographic analysis did not reveal any further loosening on the acetabular side. The survival rate of the cup at ten years, using re-dislocation as the end-point, was 86.1 ± 8.4% (95% confidence interval, 69.7-100%). The survival rate of the cup at ten years, using revision for any reason as the end-point, was 75.2 ± 9.3% (95% confidence interval, 56.9-93.5%). CONCLUSION A cemented dual mobility cup was able to restore hip stability in 94% of patients presenting with recurrent dislocating hips up to 13-year follow-up with none of the complications associated with constrained devices, as mechanical failure occurred in only 3.9% of the patients of this series. The overall reduced survival using revision for any reason as the end-point at ten years was related to this specific patients population that had various co-morbidities.
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Affiliation(s)
- Moussa Hamadouche
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France. .,Clinical Orthopaedic Research Center, Department of Orthopaedic and Reconstructive Surgery, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France.
| | - Mickael Ropars
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Department of Orthopaedic Surgery and Traumatology, Pontchaillou University Hospital, 2 Avenue Henri Le Guilloux, 35203, Rennes, France
| | - Camille Rodaix
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Clinical Orthopaedic Research Center, Department of Orthopaedic and Reconstructive Surgery, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Thierry Musset
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Clinique Mutualiste de la Porte de Lorient, 3, rue Robert de La Croix, 56324, Lorient Cedex, France
| | - François Gaucher
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Hotel Dieu, 29120, Pont Labbé, France
| | - David Biau
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Clinical Orthopaedic Research Center, Department of Orthopaedic and Reconstructive Surgery, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Jean Pierre Courpied
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Clinical Orthopaedic Research Center, Department of Orthopaedic and Reconstructive Surgery, Service A, Centre Hospitalo-Universitaire Cochin- Port Royal, 27 Rue du Faubourg St Jacques, 75014, Paris, France
| | - Denis Huten
- Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Université René Descartes, Hôpital Cochin (AP-HP), Paris, France.,Department of Orthopaedic Surgery and Traumatology, Pontchaillou University Hospital, 2 Avenue Henri Le Guilloux, 35203, Rennes, France
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20
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Plummer DR, Christy JM, Sporer SM, Paprosky WG, Della Valle CJ. Dual-Mobility Articulations for Patients at High Risk for Dislocation. J Arthroplasty 2016; 31:131-5. [PMID: 27101771 DOI: 10.1016/j.arth.2016.03.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/23/2016] [Accepted: 03/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the performance of dual-mobility articulations in patients at high risk for dislocation after revision total hip arthroplasty. METHODS We reviewed the results of 36 consecutive revision total hip arthroplasties performed on patients considered high risk for instability. Indications for inclusion included abductor insufficiency, recurrent instability, failure of constrained liner, or inadequate intraoperative stability when trialing. RESULTS At a minimum of 2 years, there were 4 (11.1%) repeat revisions including both dual-mobility liners that were cemented into an acetabular shell and 2 for deep infection treated with a 2-stage exchange. There was one dislocation that was successfully closed reduced but no revisions for recurrent instability. The mean Harris hip score improved from 45 to 90 points (P < .001). CONCLUSION Dual-mobility articulations are associated with a low rate of failure with no revisions for instability in this challenging group of patients.
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Affiliation(s)
- Darren R Plummer
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
| | | | - Scott M Sporer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois; Department of Orthopaedic Surgery, Central DuPage Hospital, Winfield, Illinois
| | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois; Department of Orthopaedic Surgery, Central DuPage Hospital, Winfield, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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