Advertisement

Clinical Orthopaedics and Related Research

, Volume 466, Issue 2, pp 389–395 | Cite as

Dual Mobility Cemented Cups Have Low Dislocation Rates in THA Revisions

  • Frantz L. Langlais
  • Mickaël Ropars
  • François Gaucher
  • Thierry Musset
  • Olivier Chaix
International Hip Society Symposium

Abstract

THA revisions using standard cups are at risk of dislocation (5.1% to 14.4% incidence), especially in patients over 70 years of age. Constrained tripolar cups have reduced this risk (6% incidence) but are associated with substantial loosening rates (9%). The nonconstrained dual mobility cup was designed to improve prosthetic stability (polyethylene head ≥ 40 mm diameter) without increasing loosening rates by reducing wear and limiting impingement (rotation range of 108°). We implanted 88 cemented dual mobility cups for THA revisions in 82 patients at high risk of dislocation. Average patient age was 72 years (range, 65–86 years). Eighty-five of the 88 hips were reviewed at 2 to 5 years followup. One patient (1.1%) had a traumatic dislocation at 2 years postoperatively. Two patients (2.3%) had asymptomatic early loosening and three patients (3.5%) had localized radiographic lucencies. These results confirm those with press-fit dual mobility cups suggesting a low dislocation rate at 5 years and a cup survival of 94.6%. At middle term followup, cemented dual mobility cup achieved better results than constrained cups in cases at risk of dislocation and recurrent loosening.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Recurrent Dislocation Impaction Grafting Severe Bone Loss Require Repeat Surgery Trochanteric Slide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Rajiv Kaila for his help in translating this manuscript.

References

  1. 1.
    Adam P, Farizon F, Fessy MH. Dual articulation retentive acetabular liners and wear: surface analysis of 40 retrieved polyethylene implants [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:627–636.PubMedGoogle Scholar
  2. 2.
    Alberton GM, High WA, Morrey BF. Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am. 2002;84:1788–1792.PubMedGoogle Scholar
  3. 3.
    Beaulé PE, Roussignol X, Schmalzried TP, Udomkiat P, Amstutz HC, Dujardin FH. Tripolar arthroplasty for recurrent total hip prosthesis dislocation [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2003;89:242–249.PubMedGoogle Scholar
  4. 4.
    Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Russell JH, Groseth KL. Long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty. J Arthroplasty. 2005;20(7 Suppl 3):93–102.PubMedCrossRefGoogle Scholar
  5. 5.
    Berend KR, Lombardi AV Jr, Welch M, Adams JB. A constrained device with increased range of motion prevents early dislocation. Clin Orthop Relat Res. 2006;447:70–75.PubMedCrossRefGoogle Scholar
  6. 6.
    Bremner RB, Goetz DO, Callaghan JJ, Capello WN, Johnston RC. Use of constrained acetabular components for hip instability: an average 10-year follow-up study. J Arthroplasty. 2003;18(7 Suppl 1):131–137.PubMedCrossRefGoogle Scholar
  7. 7.
    Brytröm S, Espehaug B, Furnes O, Havelin LI. Femoral size is a risk factor for total hip dislocation (a study of 42987 primary THR from the Norwegian Arthroplasty Register). Acta Orthop Scand. 2003;74:514–524.CrossRefGoogle Scholar
  8. 8.
    Callaghan JJ, O’Rourke MR, Goetz DD, Lewallen DG, Johnston RC, Capello WN. Use of a constrained tripolar acetabular liner to treat intraoperative instability and postoperative dislocation after total hip arthroplasty. Clin Orthop Relat Res. 2004;429:117–123.PubMedCrossRefGoogle Scholar
  9. 9.
    Cooke CC, Hozack W, Lavernia C, Sharkey P, Shastri S, Rothman RH. Early failure mechanisms of constrained tripolar acetabular sockets used in revision total hip arthroplasty. J Arthroplasty. 2003;18:827–833.PubMedCrossRefGoogle Scholar
  10. 10.
    Crowninshield RD, Maloney WJ, Wentz DH, Humphrey SM, Blanchard CR. Biomechanics of large femoral heads: what they do and don’t do. Clin Orthop Relat Res. 2004;429:102–107.PubMedCrossRefGoogle Scholar
  11. 11.
    D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–137.PubMedGoogle Scholar
  12. 12.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  13. 13.
    Farizon F, de Lavison R, Azoulai JJ, Bousquet G. Results with a cementless alumina-coated cup wear mobility. Int Orthop. 1998;22:219–224.PubMedCrossRefGoogle Scholar
  14. 14.
    Geller JA, Malchau H, Bragdon C, Greene M, Harris WH, Freiberg AA. Large diameter femoral heads on highly cross-linked polyethylene: minimum 3-year results. Clin Orthop Relat Res. 2006;447:53–59.PubMedCrossRefGoogle Scholar
  15. 15.
    Goetz DD, Bremner BR, Callaghan JJ, Capello WN, Johnston RC. Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. J Bone Joint Surg Am. 2004;86:2419–2423.PubMedGoogle Scholar
  16. 16.
    Harris WH, McCarthy JC Jr, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063–1067.PubMedGoogle Scholar
  17. 17.
    Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty. 2002;17:282–288.PubMedCrossRefGoogle Scholar
  18. 18.
    Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res. 2000;378:155–168.PubMedCrossRefGoogle Scholar
  19. 19.
    Khatod M, Barber T, Paxton E, Namba R, Fithian D. An analysis of the risk of hip dislocation with a contemporary total joint registry. Clin Orthop Relat Res. 2006;447:19–23.PubMedCrossRefGoogle Scholar
  20. 20.
    Lagrange J, Letournel E, Pupin P. Review of patients with total hip replacement after a period of more than ten years (author’s transl) [in French]. Chirurgie. 1979;105:733–737.PubMedGoogle Scholar
  21. 21.
    Langlais F, Belot N, Ropars M, Thomazeau H, Lambotte JC, Cathelineau G. Antibiotic cements in articular prostheses: current orthopaedic concepts. Int J Antimicrob Agents. 2006;28:84–89.PubMedCrossRefGoogle Scholar
  22. 22.
    Langlais F, Kerboull M, Sedel L, Ling RS. The “French paradox.”. J Bone Joint Surg Br. 2003;85:17–20.PubMedCrossRefGoogle Scholar
  23. 23.
    Langlais F, Lambotte JC, Collin PH, Langlois F, Fontaine JW, Thomazeau H. Trochanteric slide osteotomy in revision total hip arthroplasty for loosenings. J Bone Joint Surg Br. 2003,85:510–516.PubMedCrossRefGoogle Scholar
  24. 24.
    Leclercq S, el Blidi S, Aubriot JH. Bousquet’s device in the treatment of recurrent dislocation of a total hip prosthesis: apropos of 13 cases [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1995;81:389–394.PubMedGoogle Scholar
  25. 25.
    Lecuire F, Benareau I, Rubini J, Basso M. Intra-prosthetic dislocation of the Bousquet dual mobility socket [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2004;90:249–255.PubMedGoogle Scholar
  26. 26.
    Lunn JV, Kearns SS, Quinlan W, Murray P, Byrne JO. Impaction allografting and the Kerboull acetabular reinforcement device: 35 hips followed for 3–7 years. Acta Orthop. 2005;76:296–302.PubMedGoogle Scholar
  27. 27.
    Merle d’Aubigné R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am. 1954;36:451–475.Google Scholar
  28. 28.
    Muratoglu OK, Bragdon CR, O’Connor D, Perinchief RS, Estok DM 2nd, Jasty M, Harris WH. Larger diameter femoral heads used in conjunction with a highly cross-linked ultra-high molecular weight polyethylene: a new concept. J Arthroplasty. 2001;16(8 Suppl 1):24–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Peraldi P, Vandenbussche E, Augereau B. Bad clinical results of cemented caps with metal-backed acetabular components: 124 cases with 21 months follow-up [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1997;83:561–568.PubMedGoogle Scholar
  30. 30.
    Philippot R, Adam P, Farizon F, Fessy MH, Bousquet G. Survival of cementless dual mobility sockets: ten-year follow-up [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2006;92:326–331.PubMedGoogle Scholar
  31. 31.
    Phillips CB, Barrett JA, Losina E, Mahomed NN, Lingard EA, Guadagnoli E, Baron JA, Harris WH, Poss R, Katz JN. Incidence rates of dislocation, pulmonary embolism, and deep infection during the fist six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85:20–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Ritter MA. The cemented acetabular component of a total hip replacement: all polyethylene versus metal backing. Clin Orthop Relat Res. 1995;311:69–75.PubMedGoogle Scholar
  33. 33.
    Shapiro GS, Weiland DE, Markel DC, Padgett DE, Sculco TP, Pellicci PM. The use of constrained acetabular component for recurrent dislocation. J Arthroplasty. 2003;18:250–258.PubMedCrossRefGoogle Scholar
  34. 34.
    Shrader MW, Parvizi J, Lewallen DG. The use of a constrained acetabular component to treat instability after THR. J Bone Joint Surg Am. 2003;85:2179–2183.PubMedGoogle Scholar
  35. 35.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.PubMedGoogle Scholar
  36. 36.
    Zahiri CA, Schmalzried TP, Ebramzadeh E, Szuszczewicz ES, Salib D, Kim C, Amstutz HC. Lessons learned from loosening of the McKee-Farrar metal-on-metal total hip replacement. J Arthroplasty. 1999;14:326–332.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Frantz L. Langlais
    • 1
  • Mickaël Ropars
    • 1
  • François Gaucher
    • 1
  • Thierry Musset
    • 1
  • Olivier Chaix
    • 1
  1. 1.University HospitalRennesFrance

Personalised recommendations