Abstract
Introduction
Double mobility cup systems (DMCS) have gained increasing acceptance, especially in patients at high risk for dislocation. The aim of this investigation was to analyze the frequency and indications of the DMCS use in our praxis and to evaluate dislocation and cup revision rates after a minimum follow-up of 2 years.
Materials and methods
All patients implanted with a DMCS from May 2008 to August 2011 were identified from our institutional database of primary and revision THA procedures. Patient demographics, including ASA score, were recorded, along with details of the surgical procedures, indications for DMCS use, and post-operative clinical course and any complications. Radiographs were analyzed for implant positioning and radiological signs of loosening.
Results
1046 primary THA were implanted, of these 39 (4 %) primary DMCS. Indications were severe neuromuscular disease (SND) (14), hip abductor degeneration (HAD) (9), cognitive dysfunction (CD) (8) and others. 345 revision THA were performed, of these 50 (14 %) revision DMCS. Indications were recurrent dislocations (27), multiple prior hip surgeries (13), HAD (5), CD (3) and others. Overall dislocation rate was 2/89 (2 %); both in revision THA. Overall cup revision rate was 5/89 (6 %): 3 septic, 1 periprosthetic acetabular fracture, 1 “intraprosthetic dissociation”. 67 patients were available for the standardized questionnaire at a median follow-up of 43 months (range 25–78). 19 patients were not available for two-year follow-up: 17 died and two were lost to follow-up.
Conclusions
This study supports the use of DMCS constructs in primary and revision hip arthroplasty for specific high-risk patients. We continue to indicate DMCS in this patient group. We do caution against extending indications for DMCS to lower risk patient groups due to unknown issues surrounding wear and component longevity.
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References
Fackler CD, Poss R (1980) Dislocation in total hip arthroplasties. CORR 151:169–178
Hailer NP, Weiss RJ, Stark A, Kärrholm J (2012) The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78098 operations in the Swedish Hip Arthroplasty Register. Acta Orthopaedica 83(5):442–448. doi:10.3109/17453674.2012.733919
Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. JBJS Am 64:1295–1306
Berry DJ, Knoch M, Schleck CD, Harmsen WS (2004) The cumulative long-term risk of dislocation after primary charnley total hip arthroplasty. JBJS 86(1):9–14
Jolles BM, Zangger P, Leyvraz PF (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 17(3):282–288. doi:10.1054/arth.2002.30286
Alberton GM, High WA, Morrey BF (2002) Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. JBJS Am 84:1788–1792
Phillips CB, Barrett JA, Losina E et al (2003) Incidence of rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. JBJS Am. 85:20–26
Sanchez-Sotelo J, Berry DJ (2001) Epidemiology of instability after total hip replacement. Orthop Clin N AM 32(4):543–552
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. JBJS Am 60:217–220
Morrey BF (1997) Difficult complications after hip arthroplasty: dislocation. Clin Orthop 344:179–187
Woolson ST, Rahimtoola ZO (1999) Risk factors for dislocation during the first 3 months after primary total hip replacement. J Arthroplasty 14:662–668
Ekelund A, Rydell N, Nilsson OS (1992) Total hip arthroplasty in patients 80 years of age and older. Clin Orthop 281:101–106
Mahoney CR, Pellicci PM (2003) Complications in primary total hip arthroplasty: avoidance and management of dislocations. Instr Course Lect 52:247–255
Padgett DE, Warashina H (2004) The unstable total hip replacement. Clin Orthop 420:72–79. doi:10.1097/01.blo.0000122694.84774.b5
Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. JBJS 79A:1202–1210
Wetters NG, Murray TG et al (2013) Risk factors for dislocation after revision total hip arthroplasty. CORR 471:410–416. doi:10.1007/s11999-012-2561-7
Kung PL, Ries MD (2007) Effect of femoral head size and abductors on dislocation after revision THA. CORR 465:170–174
Berend KR, Lombardi AV, Mallory TH, Adams JB, Russel JH, Groseth KL (2005) The Long-term Outcome of 755 consecutive constrained acetabular Components in Total Hip Arthroplasty: examining the Successes and Failures. J Arthroplasty 20(7):93–102
Anderson MJ, Murray WR, Skinner HB (1994) Constrained acetabular components. J Arthroplasty 9:17–23
Grazioli A, Teow Hin Ek E, Rüdiger HA (2012) Biomechanical concept and clinical outcome of dual mobility cups. SICOT 36:2411–2418. doi:10.1007/s00264-012-1678-3
Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C (2011) The dual mobility socket concept: experience with 668 cases. SICOT 35:225–230. doi:10.1007/s00264-010-1156-8
Philippot R, Adam P, Farizon F, Fessy MH, Bousquet G (2006) Survie à dix ans d’une cupule double mobilité non cimentée. Revue de chirurgie orthopédique 92:326–331
Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O (2008) Dual mobility cemented cups have low dislocation rates in THA Revisions. Clin Orthop Relat Res 466:389–395. doi:10.1007/s11999-007-0047-9
Pattyn C, De Haan R, Kloeck A, Van Maele G, De Smet K (2010) Complications Encountered With the Use of Constrained Acetabular Prostheses in Total Hip Arthroplasty. J Arthroplasty 25(2):287–294. doi:10.1016/j.arth.2008.10.010
Langlais F, Lissarrague M, Ropars M, Lambotte JC, Musset T, Chaix O (2005) Prothèse totale de hanche avec cupule a double mobilité scellée. Concept-Indications- Bilan de 55 cas. Ann Orthop Ouest 37:113–120
Stuhlberg SD (2010) Dual mobility for chronic instability: solution Option. Semin Arthro 21:45–47
Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Mertl P (2011) Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 8 years‘follow up. OTSR 97:8–13. doi:10.1016/j.ostr.2010.08.003
Saikko V, Shen M (2010) Wear comparison between a dual mobility total hip prosthesis and a typical modular design using a hip joint simulator. Wear 268:617–621. doi:10.1017/j.wear.2009.10.011
Digas G, Kärrholm J, Thanner J, Herberts P (2007) 5- year experience of highly cross-linked polyethylene in cemented and uncemented sockets: two randomized studies using radiostereometric analysis. Acta Orthop 78:746–754. doi:10.1080/17453670710014518
Widmer KH (2004) A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty 19(3):387–390. doi:10.1016/j.arth.2003.10.016
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. CORR 121:20–32
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop 304:78–83
Zanetti M, Gerber C, Hodler J (1998) Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 33:163–170
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605
Miozzari HH, Dora C, Clark JM, Nötzli HP (2010) Late repair of abductor avulsion after the transgluteal approach for hip arthroplasty. J Arth 25(3):450–457. doi:10.1016/j.arth.2008.12.010
Guyen O, Pibarot V, Vaz G, Chevillotte C, Béjui-Hugues J (2009) Use of dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res 467:465–472
Saragaglia D, Ruatti S, Refaie R (2013) Relevance of press-fit dual mobility cup to deal with recurrent dislocation of conventional total hip arthroplasty: a 29-case series. Eur J Orthop Surg Traumatol 23:431–436. doi:10.1007s00590-012-1002-3
Kavanagh BF, Ilstrup DM, Fitzgerald RH (1985) Revision Total Hip Arthroplasty. JBJS 67(4):517–526
Howie DW, Holubowycz OT, Middleton R (2012) Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. JBJS Am 94:1095–1102
Garbuz DS, Masri BA, Duncan CP et al (2012) The Frank Stinchfield Award: dislocation in revision THA: do large heads (36 mm nad 40 mm) result in reduced dislocation rates in a randomized clinical trial? CORR 470:351–356
Phillipot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009) 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. SICOT 33:927–932. doi:10.1007//s00264-008-0589-9
National Australian joint and hip arthroplasty registry: annual report 2013
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Kaiser, D., Kamath, A.F., Zingg, P. et al. Double mobility cup total hip arthroplasty in patients at high risk for dislocation: a single-center analysis. Arch Orthop Trauma Surg 135, 1755–1762 (2015). https://doi.org/10.1007/s00402-015-2316-5
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DOI: https://doi.org/10.1007/s00402-015-2316-5