Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

Chalmers, Brian P.; Dubin, Jeremy A.; Westrich, Geoffrey H.

doi:10.1016/j.artd.2020.07.034

Cited by 23 publications

(23 citation statements)

References 30 publications

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“…The use of modDM implicates also the risk of modular metal liner malseating which is reported with an incidence up to 5.8%. Liner malseating may lead to increased fretting corrosion and metal related issues, component dissociation and reduced stability [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation

Tigani¹,

Banci²,

Valtorta³

et al. 2022

BMC Musculoskelet Disord

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Background Use of dual mobility (DM) in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility (modDM) systems were introduced to give the possibility to use DM with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation change with modDM. The objective of this study was to evaluate, through analytical simulation, how jumping distance, center of rotation and arc of movement change between DM and standard cups with modDM or fixed bearings (FB). Methods 3D-models of DM and standard press-fit cups with modDM or FB liners were used to simulate DM, modDM and FB implant configurations, matched for same cup size, according to same cup position and different femoral head diameters. Jumping distance was calculated and center of rotation lateralization and oscillation angles were measured for each size of these three implant configurations. Results Jumping distance with modDM was reduced by -3.9 mm to -8.6 mm in comparison with DM, from 48 to 64 mm size, but resulted comparable to polyethylene 36 mm FB and increased by + 1.1 mm and + 1.4 mm than ceramic 36 and 40 mm FBs for sizes > 54 mm. ModDM lateralized the center of rotation up to + 2.5 mm and + 4.0 mm in comparison with DM and FBs, respectively. Oscillation angle with modDM resulted higher than + 16°, + 23°, + 17° and + 14° in comparison to DM, 28 mm, 32 mm and 36 mm FB cups, respectively, for 56 mm cup size. Conclusions According to its specific design, modDM might change hip stability parameters in comparison to DM, worsening jumping distance and center of rotation position, but increasing arc of movement. As not restoring stability parameters in the same fashion, modDM implants should be properly used when DM cups are not feasible.

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Section: Discussionmentioning

confidence: 99%

Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation

Tigani¹,

Banci²,

Valtorta³

et al. 2022

BMC Musculoskelet Disord

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show abstract

“…Some possible hypotheses include a prominent acetabular screw, and soft-tissue or bone interposition at the rim of the implant. 5 - 7 , 16 , 17 In addition, the Stryker modular dual mobility liner does not sit flush with the face of the acetabular shell, making it difficult to assess if the liner is completely seated circumferentially. Another proposed explanation is that the acetabular shell can deform upon impaction into hard bone, thus slightly altering its hemispherical shape.…”

Section: Discussionmentioning

confidence: 99%

“…Techniques to reduce the risk of malseating should include thorough removal of all soft tissue and osteophytes around the periphery of the component that may impede seating of the liner and confirmation that any acetabular screws are well seated. Recently, Chalmers et al 17 found a 1.3% incidence of malseated implants in their patient cohort, and advocated using a four-quadrant test to mechanically verify proper implant engagement, particularly in the inferior segment which can be challenging to visualize intraoperatively. The four-quadrant test involves tapping the modular liner in all four quadrants using a liner impactor and assessing whether there is any movement or disengagement of the liner.…”

Section: Discussionmentioning

confidence: 99%

Malseating of modular dual mobility liners

et al. 2021

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Aims Prior studies have identified that malseating of a modular dual mobility liner can occur, with previous reported incidences between 5.8% and 16.4%. The aim of this study was to determine the incidence of malseating in dual mobility implants at our institution, assess for risk factors for liner malseating, and investigate whether liner malseating has any impact on clinical outcomes after surgery. Methods We retrospectively reviewed the radiographs of 239 primary and revision total hip arthroplasties with a modular dual mobility liner. Two independent reviewers assessed radiographs for each patient twice for evidence of malseating, with a third observer acting as a tiebreaker. Univariate analysis was conducted to determine risk factors for malseating with Youden’s index used to identify cut-off points. Cohen’s kappa test was used to measure interobserver and intraobserver reliability. Results In all, 12 liners (5.0%), including eight Stryker (6.8%) and four Zimmer Biomet (3.3%), had radiological evidence of malseating. Interobserver reliability was found to be 0.453 (95% confidence interval (CI) 0.26 to 0.64), suggesting weak inter-rater agreement, with strong agreement being greater than 0.8. We found component size of 50 mm or less to be associated with liner malseating on univariate analysis (p = 0.031). Patients with malseated liners appeared to have no associated clinical consequences, and none required revision surgery at a mean of 14 months (1.4 to 99.2) postoperatively. Conclusion The incidence of liner malseating was 5.0%, which is similar to other reports. Component size of 50 mm or smaller was identified as a risk factor for malseating. Surgeons should be aware that malseating can occur and implant design changes or changes in instrumentation should be considered to lower the risk of malseating. Although further follow-up is needed, it remains to be seen if malseating is associated with any clinical consequences. Cite this article: Bone Jt Open 2021;2(10):858–864.

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“…Use of modDM implicates also the risk of modular metal liner malseating which is reported with an incidence up to 5.8%. Liner malseating may lead to increased fretting corrosion and metal related issues, component dissociation and reduced stability [25,26].…”

Section: Discussionmentioning

confidence: 99%

Hip Stability Parameters with Dual Mobility, Modular Dual Mobility and Fixed Bearing in Total Hip Arthroplasty: an Analytical Evaluation.

Tigani

Banci²,

Valtorta³

et al. 2021

Preprint

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Background. Use of dual mobility in total hip arthroplasty has gained popularity due to the ability to reduce dislocation through increased jumping distance and impingement-free arc of movement. Recently, modular dual mobility systems were introduced to give the possibility to use dual mobility with standard metal-backed shells, however few has been studied to date regarding how jumping distance and the center of rotation changed with modular dual mobility. The objective of this study was to evaluate, through analythical simulation, how jumping distance and center of rotation change between dual mobility and standard cup with modular dual mobility or fixed bearings. Methods. 3D-models of dual mobility and standard press-fit cups with modular dual mobility or fixed bearings liners were used to simulate dual mobility, modular dual mobility and fixed bearings implant configurations, matched for same cup size, according to same cup position, different femoral head diameters. Jumping distance was calculated and center of rotation lateralization was measured for different sizes.Results. Jumping distance with modular dual mobility was reduced by -3.9mm to -8.6mm in comparison with dual mobility, from 48 to 64mm sizes. Jumping distance with modular dual mobility resulted comparable to jumping distance with polyethylene fixed bearings with Ø36mm femoral head but increased by +1.1mm and +1.4mm than jumping distance with ceramic fixed bearings with Ø36 and Ø40mm femoral heads for sizes >54mm. Modular dual mobility lateralized the center of rotation up to +2.5mm and +4.0mm in comparison with dual mobility and fixed bearings, respectively. Conclusions. Jumping distance with modular dual mobility resulted lower than dual mobility and comparable to fixed bearings polyethylene liner with Ø36mm femoral head for larger sizes. Modular dual mobility lateralized the center of rotation in comparison with both dual mobility and fixed bearings cups.

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Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

Cited by 23 publications

References 30 publications

Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation

Hip stability parameters with dual mobility, modular dual mobility and fixed bearing in total hip arthroplasty: an analytical evaluation

Malseating of modular dual mobility liners

Hip Stability Parameters with Dual Mobility, Modular Dual Mobility and Fixed Bearing in Total Hip Arthroplasty: an Analytical Evaluation.

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