A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions
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Isolated acetabular revisions using standard cups are at risk of dislocation. The introduction of a nonconstrained dual-mobility cup was designed to improve prosthetic stability without increasing loosening rates, but it is unclear whether the risk of dislocation is reduced.
We therefore determined: (1) if the rate of dislocation in isolated acetabular revisions is lower with a dual-mobility cup, (2) implant survival, (3) patient function, and (4) radiographic incidence of migration, loosening, and osteolysis.
We prospectively followed 33 selected patients who underwent isolated acetabular revisions with a minimum of 2 years’ followup (mean, 3 years; range, 2–5 years). In 24 patients a stainless steel dual-mobility cup was cemented into an antiprotrusio cage, whereas in nine we used a hyaluronan dual-mobility revision cup with a foramen hook and superior and posterior flanges screw fixations. We determined Harris hip (HHS) and WOMAC scores and examined radiographs for migration, loosening, and osteolysis.
There were no dislocations. Survivorship rates of the femoral and acetabular components were 97% at 5 years; the rerevision rate for any reason was 3%. At last followup, the mean HHS increased from 48 points preoperatively to 86 points. No patients had progressive osteolysis, component migration, or loosening on radiographs.
In this select group of isolated acetabular revisions, our data suggest the use of a dual-mobility cup reduced the risk of dislocation without increasing loosening from 2 to 5 years.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Amstutz HC, Le Duff MJ, Beaule PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res. 2004;429:108–116. CrossRef
- Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.
- Beaule PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am. 2002;84:256–263.
- Blom AW, Astle L, Loveridge J, Learmonth ID. Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br. 2005;87:1636–1638. CrossRef
- Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.
- Chen XD, Waddell JP, Morton J, Schemitsch EH. Isolated acetabular revision after total hip arthroplasties: results at 5-9 years of follow up. Int Orthop. 2005;29:277–280. CrossRef
- Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplasty. 2005;20(7 suppl 3):103–107. CrossRef
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213. CrossRef
- Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T. Should the well-fixed, uncemented femoral components be revised during isolated acetabular revision? Arch Orthop Trauma Surg. 2011;131:481–485. CrossRef
- Glassman AH. Exposure for revision: total hip replacement. Clin Orthop Relat Res. 2004;420:39–47. CrossRef
- Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.
- Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19.
- Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.
- Jamali AA, Dungy DS, Mark A, Schule S, Harris WH. Isolated acetabular revision with use of the Harris-Galante cementless component. J Bone Joint Surg Am. 2004;86:1690–1697.
- Jones CP, Lachiewicz PF. Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions. J Bone Joint Surg Am. 2004;86:342–347. CrossRef
- Khan RJ, Fick D, Alakeson R, Haebich S, de Cruz M, Nivbrant B, Wood D. A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br. 2006;88:870–876. CrossRef
- Khan RJ, Fick D, Alakeson R, Li MG, Nivbrant B, Wood D. The constrained acetabular component for hip instability. J Arthroplasty. 2007;22:377–382. CrossRef
- Khoury JI, Malkani AL, Adler EM, Markel DC. Constrained acetabular liners cemented into cages during total hip revision arthroplasty. J Arthroplasty. 2010;25:901–905. CrossRef
- Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32:46–51. CrossRef
- Lachiewicz PF, Kelley SS. The use of constrained components in total hip arthroplasty. J Am Acad Orthop Surg. 2002;10:233–238.
- Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res. 2008;466:389–395. CrossRef
- Lawless BM, Healy WL, Sharma S, Iorio R. Outcomes of isolated acetabular revision. Clin Orthop Relat Res. 2010;468:472–479. CrossRef
- Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Merl P. Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 8 years’ follow-up. Orthop Traumatol Surg Res. 2011;97:8–13. CrossRef
- Levine BR, Della Valle CJ, Deirmengian CA, Breien KM, Weeden SH, Sporer SM, Paprosky WG. The use of a tripolar articulation in revision total hip arthroplasty. J Arthroplasty. 2008;23:1182–1188. CrossRef
- Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.
- Manning DW, Ponce BA, Chiang PP, Harris WH, Burke DW. Isolated acetabular revision through the posterior approach: short-term results after revision of a recalled acetabular component. J Arthroplasty. 2005;20:723–729. CrossRef
- Massin P, Besnier L. Acetabular revision of total hip arthroplasty using a press-fit dual mobility cup. Orthop Traumatol Surg Res. 2010;96:9–13. CrossRef
- Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251. CrossRef
- McCarthy JC, Lee JA. Constrained acetabular components in complex revision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:210–215. CrossRef
- Moskal JT, Shen FH, Brown TE. The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study. J Bone Joint Surg Am. 2002;84:250–255.
- Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2011 Dec 17. [Epub ahead of print].
- Owens WB, Felts JA, Spritznagel EL. ASA physical status classification: a study of consistency of ratings. Anaesthesiology. 1978;49:239–243. CrossRef
- Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty: acetabular technique. Clin Orthop Relat Res. 1994;298:147–155.
- Philippot R, Camilleri JF, Boyer B, Adam P, Farizon F. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop. 2009;33:927–932. CrossRef
- Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F. [Survival of dual mobility socket with a mean 17 years follow-up] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:43–48. CrossRef
- Poon ED, Lachiewicz PF. Results of isolated acetabular revisions: the fate of the unrevised femoral component. J Arthroplasty. 1998;13:42–49. CrossRef
- Schneider L, Philippot R, Boyea B, Farizon F. Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res. 2011;97:807–813. CrossRef
- Tanzer M, Drucker D, Jasty M. Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg Am. 1992;74:987–994.
- Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–222. CrossRef
- A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions
Clinical Orthopaedics and Related Research®
Volume 470, Issue 12 , pp 3542-3548
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