Dual Mobility for Monoblock Metal-on-Metal Revision—Is It Safe?

Colacchio, Nicholas D.; Wooten, Clint J.; Martin, John R.; Masonis, John L.; Fehring, Thomas K.

doi:10.1016/j.arth.2019.09.028

Cited by 17 publications

(12 citation statements)

References 33 publications

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“…True dislocation (group 1) was reported in four patients during the first month from the index procedure. According to the liners implanted, two cases were related to the use of ADM/MDM X3 ® (Stryker, Mahwah, NJ, USA) [13] and another with the Active Articulation DM E1 ® , and for the fourth case the liner was not mentioned as both types were used in the series [26]. A close reduction was performed in three cases: one of them had a partial dissociation of the head during close reduction and was revised with a new polyethylene liner and a new small head.…”

Section: Resultsmentioning

confidence: 99%

“…The rationale of leaving the well-fixed acetabular component in situ and converting the implant to a dual mobility is certainly correct and starts from the assumption to reduce intra-and post-operative morbidity and to preserve bone stock, as documented by several reports [12,20,22,25,26]. Nevertheless, the incidence of so many cases of complications for a total of 10.77%, of which 10 (7.6%) of true dislocations and intra-prosthetic dislocations in a such short period of time, requires proper debate and consideration, especially considering that the majority of procedures are off-label practices, therefore unsupported by the Food and Drug Administration, the European International Medical Devices Regulators Forum and manufacturers.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors reported that cup revision in MoM can be technically difficult [13], it is often associated with loss of bone stock and could increase the risk of dislocation when small heads are used for revision surgery [14]. Therefore, it has been proposed to leave in place the acetabular component and to convert the implant into a dual mobility system [13,[15][16][17][18][19][20][21][22][23][24][25][26]. Although dual mobility (DM) bearings offer an easy solution avoiding the intraoperative and time-associated complications related to the removal of a well-fixed and well-positioned acetabular shell, other considerations should be evaluated before this new solution is considered as reliable and reproducible.…”

Section: Introductionmentioning

confidence: 99%

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Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?

et al. 2020

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Revision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetabular component exchange has been proposed in order to limit these complications. Although DM bearing offers an easy solution avoiding the intraoperative and time-associated complications, concern about polyethylene wear and stability remains due to the difference regarding the design, the coverage angle and the clearance of the two implants. In order to evaluate the performance of this new solution with the new material to prevent the possibility of failure it is essential to conduct a review of the literature A qualitative systematic review of the literature has been conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, EMBASE, Google Scholar, and Scopus for English and French articles between January 2000 and October 2019 was performed, with the primary objective of finding articles about dual mobility bearing coupling with large metal-on-metal cup in the case of hip revision procedure. Various combinations of the key words were used in the search strategy. Thirteen articles with DM bearing mated with MoM cup were analyzed. Of the 130 hip revisions selected, with a follow-up from 6 to 53 months, there were a total of 14 with complications (10.77%): four true dislocations (3.08%); six intra-prosthetic dislocations (IPD, 4.6%), two of which presented plastic deformation and polyethylene wear; four other complications (3.08%), included a cup osteolysis, a clicking noise, a superficial infection and a periprosthetic fracture. All the mentioned true dislocations occurred during the first month while IPDs appeared during the first two years from the index revision. In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with large MoM cup cannot be dissolved. It has been pointed out that a DM bearing is not designed for a MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at an even higher rate than they were in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was less optimal than modern ones.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?

et al. 2020

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“…Perrin et al conducted a prospective cohort study (level II) comparing two groups of patients who underwent revision THA for treatment of periprosthetic femur fracturesdone group who underwent revision of the acetabular cup to DM cup in addition femoral revision and another group who only underwent femoral revision. 28 They found that the postoperative dislocation rate in the DM group was 4% at a follow-up of 6 months compared to 21% in the femoral revision only group (P-value ¼ 0.19) 29 . This study did not report data later than 6 months post-operatively.…”

Section: Revision For Periprosthetic Femur Fracturesmentioning

confidence: 99%

“…Colacchio et al conducted a retrospective comparative study of 143 patients with monoblock metal-on-metal (MoM) THA who underwent revision THA for metal hypersensitivity reaction, bearing surface wear, or taper corrosion giving rise to adverse local tissue reaction. 29 One group underwent conversion to a DM construct with monoblock cup retention while the second group complete revision of the acetabular component. They found that DM cohort had a revision rate of 6.9% at a mean follow up of 47 months while the complete revision cohort had a 20% major complication rate and a 16% revision rate (P-value ¼ 0.1229) 30 .…”

Section: Revision Of Metal-on-metal Arthroplastiesmentioning

confidence: 99%

Use of dual mobility components in total hip arthroplasty: Indications and outcomes

Vajapey

Fideler

Lynch

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Instability after total hip arthroplasty (THA) can be a problematic complication and remains one of the leading causes of revision surgery in the early post-operative period. Dual mobility (DM) implants decrease dislocation risk after THA but they come with their own set of complications. Selective use of DM implants for THA in high risk groups can confer the advantages of this construct while mitigating the risks. In this paper, we review the current literature to examine the evidence for or against use of DM implants in various clinical scenarios and provide an algorithm for when to consider using DM design construct in THA.

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Revisionsendoprothetik des Hüftgelenkes: Tripolare Pfannen – Double Mobility

Ascherl,

Perka

2023

AE-Manual Der Endoprothetik

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Dual Mobility for Monoblock Metal-on-Metal Revision—Is It Safe?

Cited by 17 publications

References 33 publications

Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?

Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?

Use of dual mobility components in total hip arthroplasty: Indications and outcomes

Revisionsendoprothetik des Hüftgelenkes: Tripolare Pfannen – Double Mobility

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