Intra-prosthetic dislocation of dual-mobility cups after total hip arthroplasty: potential causes from a clinical and biomechanical perspective

Fabry, Christian; Langlois, Jean; Hamadouche, Moussa; Bader, Rainer

doi:10.1007/s00264-015-3000-7

Cited by 52 publications

(34 citation statements)

References 35 publications

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“…IPD incidence or retentive failure (RF) ranging from 1.9 to 5.2 % is reported with older-generation DM designs at a mean follow-up of four to 17 years [8,21,52,53], with the oldergeneration design at a mean follow-up of four to 17 years and 0-2.4 % at seven years with the newer-generations design [12,22,54] (Table 3). Rates appear to be dependent not only on cup design but also neck design.…”

Section: Intraprosthetic Dislocation As Results Of Pe Wearmentioning

confidence: 99%

“…Although a radiostereometric method was conceived by Pineau et al [51] to measure femoral head migration inside the cup, to our knowledge, it has not been applied to measure in vivo wear. Moreover, indirect sign of poly wear is granulomatous osteolysis [52,53], which is correlated with age and activity level. Vielpeau at al.…”

Section: Wear and Its Clinical Relevance In Dm Designmentioning

confidence: 99%

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Wear of dual-mobility cups: a review article

Laura

Hothi

Battisti

et al. 2016

International Orthopaedics (SICOT)

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Dual-mobility (DM) cups have been clinically used in hip surgery in Europe for more than 35 years and continue to gain popularity worldwide due to promising results at reducing instability. Concerns related to polyethylene wear apply as in conventional standard bearings but are accentuated by the larger-diameter articulations with multiple surfaces. We critically reviewed the reported literature regarding the in vivo and in vitro wear occurring on all surfaces involved. We looked for patterns to create a rational classification of sites of wear and to identify areas for future research. Wear was a significant problem for first-generation designs and appeared to be design related. Improved polyethylene, thinner and smoother trunnions, chamfered rims and eccentric configuration of insert and shell seem to enhance outcome performance; however, long-term clinical evidence and retrieval studies are needed to better understand the balance of benefit and risk when opting for DM bearings.

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Section: Intraprosthetic Dislocation As Results Of Pe Wearmentioning

confidence: 99%

Section: Wear and Its Clinical Relevance In Dm Designmentioning

confidence: 99%

Wear of dual-mobility cups: a review article

Laura

Hothi

Battisti

et al. 2016

International Orthopaedics (SICOT)

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“…Fabry et al 24 reviewed intraprosthetic dislocations around DM hips. One of the advantages of the DM implant is that the majority of the hip range of motion occurs at the smaller inner bearing.…”

Section: Discussionmentioning

confidence: 99%

“…In recent times, increasing awareness of intraprosthetic dislocation is growing 21 26–28. The incidence has been reported from 0% to 5.3% 24. There is no consensus on the timing of these dislocations occurring with some series reporting early dislocations1 while other series have reported as distant as 16 years 24.…”

Section: Discussionmentioning

confidence: 99%

Cause of irreducible dislocation of a re-revision THR

Murphy¹,

Fenelon

Russell

et al. 2018

BMJ Case Reports

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Instability or recurrent dislocations are a common reason for revision of total hip replacements (THRs). Dual-mobility constructs can help improve stability by increasing the femoral head jump distance. These constructs are used to decrease the risk of re-revision in the setting of recurrent dislocation. This case describes an unusual case of irreducible dislocation of a re-revision THR due to intraprosthetic dislocation. The patient required open reduction and revision of this construct to a tripolar implant. This is important to appreciate from an emergency medicine point of view as repeated attempts at reduction will be fruitless and may result in a femur fracture. This particular type of dislocation is very rare. Perioperative considerations should include early referral to the orthopaedic team for reduction in theatre, and having a low threshold for open reduction. Revision options should be available when bringing a case like this to the operating theatre.

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“…Clinical studies have highlighted that neck thickness and surface topography are important factors associated with poly wear of DM cups and play a role in the weakening of the retentive power of the poly liners ultimately leading to IPD of these bearing systems [7,8,[16][17][18][19]. Data on small numbers of retrievals is available [10,11,14,20], but there have been no attempts at quantifying the damage at the rim and at reporting when it is likely to occur in-vivo.…”

Section: Discussionmentioning

confidence: 99%

Retrieval evidence of impingement at the third articulation in contemporary dual mobility cups for total hip arthroplasty

Laura

Hothi

Henckel

et al. 2017

International Orthopaedics (SICOT)

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Purpose We aimed to assess polyethylene liners of retrieved hips of one design of a dual mobility (DM) cup liner and two designs of femoral stems to better understand the role of femoral stem design on polyethylene impingement. Methods This was a case-control study involving 70 retrieved highly cross-linked polyethylene (X3) liners used with ABGII (n = 35) and Rejuvenate (n = 35) stems (Stryker). All polyethylene liners were assessed for evidence of rim deformation and the damage quantified using metrology methods. Results A total of 80% of polyethylene liners paired with ABGII necks had macroscopic evidence of neck impingement resulting in a raised lip whilst 23% of liners paired with Rejuvenate necks had evidence of a raised lip (p < 0.0001). The height of the raised rims of the DM cups paired with ABGII necks had a median (range) of 139 μm (72-255). The height of the raised rims of the DM cups paired with Rejuvenate necks had a median (range) of 52 μm (45-90) (p < 0.0001). ConclusionOur new findings from retrieved dual mobility bearings showed that polyethylene liner rim deformation resulting from impingement with the femoral neck occurs in early in-human function, is circumferential in distribution, and is affected by the stem neck design. We recommend the use of highly polished and non-edged neck designs when used in conjunction with DM cups.

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Intra-prosthetic dislocation of dual-mobility cups after total hip arthroplasty: potential causes from a clinical and biomechanical perspective

Cited by 52 publications

References 35 publications

Wear of dual-mobility cups: a review article

Wear of dual-mobility cups: a review article

Cause of irreducible dislocation of a re-revision THR

Retrieval evidence of impingement at the third articulation in contemporary dual mobility cups for total hip arthroplasty

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