The Use of a Constrained Acetabular Component to Treat Instability After Total Hip Arthroplasty

Use of a Dual Mobility Socket to Manage Total Hip Arthroplasty Instability

“…Moreover, the complexity of the mechanisms of constrained components involving many parts raises concerns regarding the potential for mechanical failure as reports began to emerge [15,29,60]. It therefore seems logical to suggest caution in the use of these constraining devices [9,15,52].…”

“…The dual-mobility component was used to treat instability in three situations: (1) patients in whom no identifiable cause for instability could be identified or corrected; (2) patients in whom prior surgical attempts at stabilization failed; and (3) patients with a marked deficiency of the hip abductors. We advocate the use of a dualmobility acetabular component instead of a constraining device in such situations, given the previously raised concerns regarding the potential for loosening and failure with constrained implants [29,52]. There were 35 women and 19 men, and the average age at the time of the revision was 66.5 years (range, 35.7-98.7 years).…”

“…However, success to achieve stability is highly variable [3,26,50] and depends on the constrained component design [24]. Additionally, such devices raise concerns regarding the potential for increased wear, osteolysis, loosening, and implant disassembly as reports of failure begin to emerge [15,29,52,56,60].…”

The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation

“…The time is adequate for identifying most patients with recurrent dislocation after the procedure, but not to determine long-term survival. However, with similar followup, other designs have proved unsatisfactory in terms of redislocation prevention [2] or worrisome in terms of actual or potential mechanical failures, including constraint mechanism breakage or radiographic loosening [26,45].…”

“…Tripolar constrained devices reportedly provide 90% survival at 10-year followup with revision for redislocation or mechanical failure of the constraining mechanism as the end point [16]. However, other reports show lower rates of reducing recurrent dislocation even in the short-term, pointing out specific mechanisms of failure at each interface [10,13,20] and rates of actual or potential loosening of 12% after less than 3-year followup [26,45,49]. Another concept introduced in the late 1970s by Bousquet [7] to deal with these complex situations is an unconstrained tripolar device, a so-called dual mobility socket.…”