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Dual-mobility arthroplasty failure: a rationale review of causes and technical considerations for revision

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Abstract

Purpose

Dual-mobility arthroplasty is an alternative to conventional total hip arthroplasty (THA) in appropriately selected, active adults with degenerative, necrotic or post-traumatic hip disease or with revision hip arthroplasty. Numerous papers have been published with results of dual-mobility arthroplasty, but there have been no comprehensive literature reviews that summarise the most recent findings and help the orthopaedic surgeon facing different scenarios in which revision of one or both components of a dual-mobility arthroplasty is indicated.

Methods

We performed a PubMed search for papers published on dual-mobility arthroplasty that provided data on revision and add our experience in order to describe different revision scenarios. We collected data on revision for any reason, for aseptic loosening, for infection, or for dislocation. For each complication, we summarise causes and diagnosis of this complication and describe the direction of possible therapeutic options.

Results

The dual-mobility arthroplasty offers the benefit of increased stability without compromising clinical outcomes and implant longevity. However, as with conventional arthroplasties, complications are also reported, with the most frequent being cup loosening, dislocation, accelerated wear and infection. Dual-mobility implants also have some specific complications secondary to their specific design, with the presence of a third joint. For example, intraprosthetic dislocation due to retentive failure of the polyethylene (PE) liner on the femoral head is a complication observed exclusively with this type of implant and involves articulation failure between the femoral head and the PE liner. Mechanical conflict with the iliopsoas tendon has also been reported, probably due to femoral head size, cup design, and/or a dysplastic hip. This systematic review of the literature identified several options for treating each complication, and in particular, options regarding conserving or not of one the two articulating devices.

Conclusions

These findings can inform discussions relating to risks and benefits of different therapeutic options when performing revision of a dual-mobility arthroplasty.

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Authors and Affiliations

  1. Chirurgie Orthopedique, Hopital Henri Mondor, 51 Av Mal de Lattre de Tassigny, Creteil, 94000, France

    Philippe Hernigou, Arnaud Dubory, Damien Potage, François Roubineau & Charles Henri Flouzat Lachaniette

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  1. Philippe Hernigou
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  2. Arnaud Dubory
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  3. Damien Potage
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  4. François Roubineau
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  5. Charles Henri Flouzat Lachaniette
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Correspondence to Philippe Hernigou.

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All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Hernigou, P., Dubory, A., Potage, D. et al. Dual-mobility arthroplasty failure: a rationale review of causes and technical considerations for revision. International Orthopaedics (SICOT) 41, 481–490 (2017). https://doi.org/10.1007/s00264-016-3328-7

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  • DOI: https://doi.org/10.1007/s00264-016-3328-7

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