Lack of Early Dislocation following Total Hip Arthroplasty with a New Dual Mobility Acetabular Design

Vigdorchik, Jonathan M.; D’Apuzzo, Michele R.; Markel, David C.; Malkani, Arthur L.; Raterman, Stephen; Sharpe, Kipling P; Cornell, Charles N.; Westrich, Geoffrey H.

doi:10.5301/hipint.5000186

Cited by 51 publications

(28 citation statements)

References 31 publications

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“…After reviewing the abstracts of these, 75 were screened for eligibility and 16 were identified for inclusion. Fifty-nine articles were excluded because reporting no IPD episodes (30 articles) [7] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , IPD episodes were not mentioned (13) [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , reporting delayed IPD episodes (13) [8] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , reporting early IPD episodes with old DM designs with small femoral heads (2) [9] , [69] , and reporting a suspicious IPD episode (1) [70] ( Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

et al. 2017

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BackgroundDual 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.MethodsA 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.”ResultsIn 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.ConclusionsBased 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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Section: Resultsmentioning

confidence: 99%

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

et al. 2017

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“…24 Clinically, encouraging reports with the use of highly cross-linked polyethylene are emerging; however, follow-up remains limited to date. 25-27 …”

Section: Dual Mobilitymentioning

confidence: 99%

Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA

Guyen

2016

EFORT Open Reviews

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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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“…Regarding management, we chose to revise the hip with a dual-mobility cup to reduce the risk of future dislocation given extensive soft tissue disruption in part due to metallosis [40] . We recommend that surgeons take particular care to ensure that the liner is properly seated and engaged at the time of implantation, especially when using Oxinium femoral heads.…”

Section: Discussionmentioning

confidence: 99%

Liner dissociation leading to catastrophic failure of an Oxinium femoral head

et al. 2019

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Oxinium is an alternative bearing surface designed to emulate the superior wear and scratch properties of ceramic femoral heads in total hip arthroplasty while minimizing the risk for brittle fracturing. However, recent studies have indicated that hip dislocation following total hip arthroplasty may be a risk factor for catastrophic failure of the femoral head. Here, we report on a novel case of a catastrophic Oxinium head and polyethylene liner failure in the absence of previous hip dislocation or trauma and review the probable failure mechanism. This report underscores the need to be vigilant about proper acetabular cup and liner seating, particularly in the setting of Oxinium femoral head use. In the event of Oxinium head failure, metallosis may compromise stabilizing soft tissues including the abductors. Dual-mobility articulation, which was successful in this case, is one option to consider when the risk for chronic redislocation is elevated.

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Lack of Early Dislocation following Total Hip Arthroplasty with a New Dual Mobility Acetabular Design

Cited by 51 publications

References 31 publications

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA

Liner dissociation leading to catastrophic failure of an Oxinium femoral head

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