Dislocation following total hip arthroplasty using dual mobility acetabular components

Martino, Ivan De; D’Apolito, Rocco; Soranoglou, Vasileios; Poultsides, Lazaros; Sculco, Peter K.; Sculco, Thomas P.

doi:10.1302/0301-620x.99b1.bjj-2016-0398.r1

Cited by 171 publications

(113 citation statements)

References 108 publications

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“…Dual-mobility cups are thought to lower the risk of dislocation by minimizing prosthetic neck impingement and increasing range of motion via the large articulation between the insert and metallic shell [6,25]. The utility of this design concept is borne out by low dislocation rates reported in several studies this decade with cementless dual-mobility cups [6][7][8][9][10][11]. In the current study, there were no dislocations in any subjects.…”

Section: Discussionmentioning

confidence: 66%

“…Early dual-mobility cups proved adept at decreasing dislocation rates, particularly among elderly patients at high risk for this outcome [5]. Similarly encouraging results have been reported with later-generation dual-mobility cups [6][7][8][9][10][11]. The continued positive safety and performance observed with these designs has extended their use into younger, more active patients [12], as well as the obese [13].…”

Section: Introductionmentioning

confidence: 84%

See 1 more Smart Citation

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

Cypres¹,

Fiquet

P³

et al. 2019

J Orthop Surg Res

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Background: The separate design concepts of dual-mobility cups and triple-taper femoral stems were developed to improve survivorship following total hip replacement (THR) by reducing instability/dislocation and enabling enhanced fixation. Successful outcomes at over two decades have been reported with earlier-generation devices based on these concepts. The current study aimed to provide the first long-term results with a unique pairing of later-generation dual-mobility cup and triple-taper cementless femoral stem after a decade of use in patients undergoing THR. Methods: In this retrospective analysis, records were reviewed for all subjects implanted with this dual-mobility cup/cementless femoral stem combination at three centers between 2002 and 2005. Any subject who had not already had follow-up visit beyond 10 years, was not previously revised, and still living were invited for a single follow-up visit consisting of Merle d'Aubgine Scores, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and standard radiographs. Results: There were 244 THRs available for analysis. At a mean follow-up of 11.9 years, the Kaplan-Meier survivorship (endpoint: revision for any reason) was 99.1% (95% CI, 97.6-99.7) for the stem and 95.9% (95% CI, 93.1-97.6) for the cup. Merle d'Aubigne Scores were significantly improved from baseline and WOMAC scores were in the satisfactory range at the final follow-up. Radiographic analysis revealed no cases of stem subsidence, no cases of bone hypertrophy, 1 (0.4%) case of bone atrophy, and 3 (1.2%) cases of osteolysis around the stem. No subjects had radiolucent lines greater than 1 mm in any femoral Gruen zone. Evidence of cup migration was seen in 1 (0.4%) subject and 1 (0.4%) subject had evidence of osteolysis that was seen in Gruen zones I, II, IV, and V. Conclusions: This combination of a later-generation dual-mobility cup and cementless triple-taper stem was associated with excellent survivorship and satisfactory functional outcomes at over 10 years follow-up.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 84%

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

Cypres¹,

Fiquet

P³

et al. 2019

J Orthop Surg Res

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“…Gwam et al conducted an epidemiological survey using the National Inpatient Samples (NIS) database and found that dislocation‐related acetabular revision occurs in 24.7% of the cases out of 53,508 cases requiring revision surgery. One of the strategies employed to reduce the risk of dislocation in high‐risk patients is to incorporate a dual‐mobility articulation . As the number of THAs has risen each year, the risk of dislocation has remained more or less constant.…”

Section: Introductionmentioning

confidence: 99%

In vitro test methods for seating and fretting corrosion behavior of modular metal‐on‐metal acetabular tapers

Shenoy

Gilbert

2019

Journal Orthopaedic Research

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Retrieval studies show that metal-on-metal acetabular shell-liner tapers are susceptible to corrosion, which is hypothesized to arise from mechanically-assisted crevice corrosion (MACC). The role of materials on MACC of acetabular tapers has not been previously studied. In vitro tests of seating, pushout, and fretting corrosion performance of acetabular tapers are presented to assess the role of material combinations (Ti-6Al-4V shells, HC CoCrMo, LC CoCrMo, and 316L SS liners). The acetabular tapers were wetassembled to a seating load of 1,000 N. The liner load-displacement seating mechanics were measured. Fretting corrosion currents were evaluated using a uniaxial incremental cyclic compression test up to 4,000 N, with the load applied at a 55°angle to the taper interface. Fretting currents, fretting onset loads, taper disengagement strength were measured and load-displacement plots were obtained. Pushout tests were also performed pre-and post-fretting corrosion. The average liner seating displacements varied from 134 to 226 μm across groups. Fretting currents at 3,600 N cyclic load were low and ranged between 0.05 and 0.27 μA and were independent of material combination (p > 0.05), reflecting small amounts of fretting. Fretting corrosion onset loads were between 1,800 and 2,100 N, and did not differ across groups (p > 0.05). Pushout loads were 27-43% of the maximum load applied. Fretting corrosion levels were very low for all material combinations and not different from one another. The seating and pushout responses were also not material dependent. The low fretting currents measured imply that MACC may not be a major cause for acetabular taper corrosion.

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“…однако в условиях реэндопротезирования возможность соблюдения данной рекомендации ограничена вследствие сохранения хорошо фиксированных ножек. не случайно по данным сис тематического обзора I. de Martino с соавторами, средняя частота возникновения внутрипротезных вывихов после ревизий превышает таковую после первичных операций и составляет 1,3% (Sd 2,2%) [32].…”

Section: Introductionunclassified

“…асептическое расшатывание вертлужного компонента двойной мобильности в представленный срок наблюдения развилось в 1 случае в результате травмы. отсутствие механической связанности системы исключает значимую нагрузку на границе «вертлужный компонент -кость» в случае возникновения импинджмента, однако в условиях ревизионного эндопротезирования с дефектами вертлужной впадины отсутствие отверстий для винтов в полусфере немодульных компонентов может ограничить возможность достижения надежной первичной фиксации, если система имплантируется не в антипротрузионный кейдж или бесцементный компонент большого диаметра [32].…”

Section: Introductionunclassified

Constrained Liners and Dual Mobility Systems for Prevention of Instability in Revision Hip Arthroplasty

Ефимов

Стафеев

Ласунский

et al. 2018

Traumatology and Orthopedics of Russia

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Purpose.Instability is a challenging complication of revision hip arthroplasty and a frequent cause of repeatrevisions. Constrained liners and dual mobility systems have gained major attention among the options of dislocation prophylaxis. The aimof this study is to compare the outcomes of revision hip arthroplasy with use of constrained liners and dual mobility systems. Materials and Methods.We used DePuy Duraloc (inner diameter 28 mm) and Zimmer Trilogy (inner diameter32 mm) systems in the constrained liners group (N 78, mean follow-up — 66.2 month, 54-82), Serf Novae and Biomet Avantage systems in the dual mobility group (N 58, mean follow-up — 17.8 month, 10-41). The two groups were comparable in age, sex and different potential dislocation risk factors, however, dual mobility cups were used more frequently in revisions due to unreduced and recurrent dislocations and in patients with the history of instability following total hip arthroplasty. There were also differences in the structure of primary diagnosis. Results.We observed 14 (17.9%) dislocations, 10 (12.8%) of which occurred within 2 years after surgery, and also3 (3.8%) cases of aseptic loosening of the acetabular component, 4 (5.1%) cases of locking mechanism damage without dislocation and 8 (10.3%) cases of deep infection in the constrained liners group. In the dual mobility group we observed 3 (5.17%) large articulation dislocations, 1 (1.7%) case of aseptic loosening of the acetabular component and 4 (6.9%) cases of deep infection. The difference in dislocation rates in two groups was significant (p<0.05). The analysis of the constrained liners group revealed an increased risk of dislocation in cases when a constrained system was implanted into a retained acetabular component compared to cases with acetabular shell revision (p<0.01; RR = 7.2, 95% CI: 2.05-25.26), as well as a trend for increased risk of dislocation in cases when DePuy Duraloc liners (inner diameter 28 mm) were used compared to Zimmer Trilogy (inner diameter 32 mm) (p= 0.07; RR = 4.97, 95% CI: 1.03-24.04). Conclusion. Dual mobility systems proved to be more effective than constrained liners in revision hip arthroplastyalthough being used more frequently as a treatment rather than prophylaxis of instability. Constrained liners bear a higher risk of dislocations when implanted into retained acetabular components and when used with heads of lesser diameter.

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Dislocation following total hip arthroplasty using dual mobility acetabular components

Cited by 171 publications

References 108 publications

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

In vitro test methods for seating and fretting corrosion behavior of modular metal‐on‐metal acetabular tapers

Constrained Liners and Dual Mobility Systems for Prevention of Instability in Revision Hip Arthroplasty

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