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What is the rate of successful closed reduction of dislocated dual mobility cups following complex revision hip arthroplasty?

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the difference in success rates of closed reduction in septic and aseptic revision total hip arthroplasty (THA) performed with a dual mobility (DM) implant. Our objective was to answer the following questions: (1) Is there a difference in success rates of closed reduction between septic and aseptic revision THA with a DM implant? (2) Is closed or open reduction more successful in preventing re-dislocation?

Methods

Between January 2009 and October 2021, 924 revisions were performed with a DM implant. All patients presenting to our institution with a dislocation following septic or aseptic revision THA using a cemented DM cup were included in this study. We analyzed 106 cases of dislocation in 74 patients. For all patients, we collected reason for revision, and classified index surgery as septic or aseptic.

Results

Overall, 106 dislocations occurred (106/924, 11.5%). Thirty-nine cases (52.7%) had a dislocation after a septic exchange THA, while in 35 patients (47.3%), a dislocation occurred after an aseptic rTHA. In 29 patients (39.2%), successful closed reduction under general anesthesia was feasible, while the majority of cases required open reduction. In 31 of these patients (67.4%), open reduction was combined with a revision arthroplasty.

Conclusions

In case of DM cup dislocation, there is a low success rate of closed reduction. To prevent re-dislocation, total revision leads to a significantly reduced risk compared to open or closed reduction alone. Careful X-ray analysis for a halo sign showing intra-prosthetic DM cup dislocation is mandatory to avoid futile reduction attempts.

Level of evidence

III.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Only authors have full access to the dataset

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Author notes

  1. Niklas Unter Ecker, and Rudy Sangaletti contributed equally to writing this article.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany

    Niklas Unter Ecker, Rudy Sangaletti, Malte Ohlmeier, Mustafa Akkaya, Seper Ekhtiari,  Ianiv Klaber, Thorsten Gehrke & Mustafa Citak

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  1. Niklas Unter Ecker
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Corresponding author

Correspondence to Mustafa Citak.

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Conflict of interest

M.C. has received funding from W. Link & Co KG outside the submitted work. T.G. has received funding from W. Link & Co KG, Zimmer Biomet Inc., Heraeus and from Ceramtec Co. outside the submitted work. The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.

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Ethical approval was performed and has following number: 2022-300154-WF.

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The study was performed at the Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.

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Unter Ecker, N., Sangaletti, R., Ohlmeier, M. et al. What is the rate of successful closed reduction of dislocated dual mobility cups following complex revision hip arthroplasty?. Arch Orthop Trauma Surg 143, 6439–6445 (2023). https://doi.org/10.1007/s00402-023-04826-w

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