Outcomes for cemented dual mobility cup to treat recurrent instability; A UK case series

Abstract

Recurrent dislocation of Total Hip Replacement (THR) is often multifactorial and remains a significant surgical challenge with a significant risk of further instability. Dual Mobility Cups (DMC) have been used widely with good long term results in France with few studies in the British literature, especially assessing their use for recurrent instability. We set out to assess whether recurrent instability can be successfully treated solely with revision of acetabular component to a dual mobility cup. Methods: We retrospectively reviewed a prospectively collected electronic database for all consecutive dual mobility cups implanted to address recurrently instability in THR. Radiological and clinical data have been analysed. Results: From September 2013 to September 2017 54 dual mobility cups have been implanted, mean age 78 (range 49-97). 47 were 1st time revision procedures, 7 were following previous revisions including 5 failed PLADs. Average time post primary was 10 years (range 8 months-23 years). Twenty cases are cement in cement revisions which has become our primary technique for revision of cemented cups. Mean follow up is 1.9 years (range 6 months-5 years), 37 cases have 2 year follow up available. 8 patients have died. There have been no episodes of further instability. One patient has had reoperation for infection (1st stage revision). Conclusions: This series demonstrates satisfactory early to mid-term results for the use of dual mobility cups to treat recurrent instability. The technique is particularly useful when femoral components are well fixed and can be used with monoblock implants such as the Charnley stem. Cement in cement revision is a convenient technique and potentially reduces complications and cost. Further analysis of longer term data is required but these results suggests this could be a valid solution to a complex problem.

Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review

“…The full texts of the remaining 86 articles were examined. Finally, according to the eligibility criteria, 56 articles were included in the systematic review [ 12 , 14 , 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 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] ( Figure 1…”

Risk factors and modes of failure in the modern dual mobility implant. A systematic review and meta-analysis

“…Another 58 studies were excluded after reading the full text as the studies did not meet the inclusion criteria: studies on different outcome domains (n=21), mixed etiologies (n=12), 1st generation DM designs (n=10), cemented liner to cup (n=9), cadaveric or in vitro studies (n=3), studies not written in English (n=3). After exclusion, a total of 119 studies were included [ 41 – 115 , 120 – 163 ] (Figure 1 ). Of these studies, 45 were case-control studies while 74 were case series.…”

Outcomes of Dual Mobility Bearings in Revision Total Hip Replacements

“…This data is comparable to published literature on dual mobility bearings in revision total hip replacements [ 7 , 11 ]. A recent UK case series of revision total hip replacements using dual mobility bearings to treat recurrent instability demonstrated a re-dislocation rate of 0% in early- to mid-term follow-up [ 23 ]. Similarly, the rate of dislocation in revision total hip replacement surgery has been reported as low as 3.5% with dual mobility bearings [ 11 ].…”