Modular dual-mobility articulations in patients with adverse spinopelvic mobility

Abstract

Aims Adverse spinal motion or balance (spine mobility) and adverse pelvic mobility, in combination, are often referred to as adverse spinopelvic mobility (SPM). A stiff lumbar spine, large posterior standing pelvic tilt, and severe sagittal spinal deformity have been identified as risk factors for increased hip instability. Adverse SPM can create functional malposition of the acetabular components and hence is an instability risk. Adverse pelvic mobility is often, but not always, associated with abnormal spinal motion parameters. Dislocation rates for dual-mobility articulations (DMAs) have been reported to be between 0% and 1.1%. The aim of this study was to determine the early survivorship from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) of patients with adverse SPM who received a DMA. Methods A multicentre study was performed using data from 227 patients undergoing primary total hip arthroplasty (THA), enrolled consecutively. All the patients who had one or more adverse spine or pelvic mobility parameter had a DMA inserted at the time of their surgery. The mean age was 76 years (22 to 93) and 63% were female (n = 145). At a mean of 14 months (5 to 31) postoperatively, the AOANJRR was analyzed for follow-up information. Reasons for revision and types of revision were identified. Results The AOANJRR reported two revisions: one due to infection, and the second due to femoral component loosening. No revisions for dislocation were reported. One patient died with the prosthesis in situ. Kaplan-Meier survival rate was 99.1% (95% confidence interval 98.3 to 100) at 14 months (number at risk 104). Conclusion In our cohort of patients undergoing primary THA with one or more factor associated with adverse SPM, DM bearings conferred stability at two years’ follow-up. Cite this article: Bone Joint J 2022;104-B(7):820–825.

Comparing dislocation rates by approach following elective primary dual mobility total hip arthroplasty: a systematic review

“…Of the 63 articles included, 11 reported outcomes for two different approaches in the same study [ 10 , 33 , 40 , 43 , 49 , 50 , 52 , 69 , 79 , 84 ], and one study reported three approaches [ 74 ], resulting in 75 total study arms. Eight studies reported the DAA, five reported the ALA, six reported the DLA, and 56 studies reported the PLA (Table 1 ).…”

Mid-Term Outcomes of Modular Dual Mobility Bearings in Total Hip Arthroplasty

“…15 MDM implants have been shown to decrease instability in patients at high risk of dislocation. Dhawan et al 16 reported zero dislocations among a cohort of 227 patients undergoing pTHA who were identified as high risk for instability. In terms of rTHA, the literature is similarly positive, with a 2022 retrospective review by Park et al 17 demonstrating no re-dislocations in 34 patients undergoing rTHA for recurrent dislocation.…”

Functional implant positioning in total hip arthroplasty and the role of robotic-arm assistance

“…Utilisation of dual mobility cups could also represent a practical solution in patients with a stiff spine and a bail-out option in cases where persistent impingement is evident [ 33 , 34 ]. It has been shown that they can minimise dislocations after primary THA [ 35 ] and a recent study from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) has reported 99.1% survival at 14 months [ 36 ]. While dual mobility articulations could help mitigate the dislocation risk, one should consider that a real benefit regarding ROM is seen with the larger acetabular cups.…”