Clinical Orthopaedics and Related Research

, Volume 467, Issue 2, pp 465–472 | Cite as

Use of a Dual Mobility Socket to Manage Total Hip Arthroplasty Instability

  • Olivier GuyenEmail author
  • Vincent Pibarot
  • Gualter Vaz
  • Christophe Chevillotte
  • Jacques Béjui-Hugues
Original Article


Unconstrained tripolar hip implants provide an additional bearing using a mobile polyethylene component between the prosthetic head and the outer metal shell. Such a design increases the effective head diameter and therefore is an attractive option in challenging situations of unstable total hip arthroplasties. We report our experience with 54 patients treated using this dual mobility implant in such situations. We ascertained its ability to restore and maintain stability, and examined component loosening and component failure. At a minimum followup of 2.2 years (mean, 4 years; range, 2.2–6.8 years), one hip had redislocated 2 months postoperatively and was managed successfully without reoperation by closed reduction with no additional dislocation. Two patients required revision of the implant because of dislocation at the inner bearing. Technical errors were responsible for these failures. Three patients had reoperations for deep infections. The postoperative radiographs at latest followup showed very satisfactory osseointegration of the acetabular component because no radiolucent line or osteolysis was reported. Use of this unconstrained tripolar design was successful in restoring and maintaining hip stability. We observed encouraging results at short-term followup regarding potential for loosening or mechanical failures.

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


Femoral Head Femoral Component Heterotopic Ossification Acetabular Component Late Followup 
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.



We thank Professor Jean-Paul Carret for his contribution to this study.


  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.
    Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg Br. 1981;63:214–218.PubMedGoogle Scholar
  3. 3.
    Anderson MJ, Murray WR, Skinner HB. Constrained acetabular components. J Arthroplasty. 1994;9:17–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Attarian DE. Bipolar arthroplasty for recurrent total hip instability. J South Orthop Assoc. 1999;8:249–253.PubMedGoogle Scholar
  5. 5.
    Aubriot JH, Lesimple P, Leclercq S. [Study of Bousquet’s non-cemented acetabular implant in 100 hybrid total hip prostheses (Charnley type cemented femoral component): average 5-year follow-up][in French]. Acta Orthop Belg. 1993;59(suppl 1):267–271.PubMedGoogle Scholar
  6. 6.
    Beaule 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
  7. 7.
    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.PubMedGoogle Scholar
  8. 8.
    Berend KR, Lombardi AV Jr, Mallory TH, Adams JB, Russell JH, Groseth KL. The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and failures. J Arthroplasty. 2005;20(suppl 3):93–102.PubMedCrossRefGoogle Scholar
  9. 9.
    Berry DJ. Unstable total hip arthroplasty: detailed overview. Instr Course Lect. 2001;50:265–274.PubMedGoogle Scholar
  10. 10.
    Bradbury N, Milligan GF. Acetabular augmentation for dislocation of the prosthetic hip: a 3 (1–6)-year follow-up of 16 patients. Acta Orthop Scand. 1994;65:424–426.PubMedGoogle Scholar
  11. 11.
    Bremner BR, Goetz DD, 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(suppl 1):131–137.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    Cobb TK, Morrey BF, Ilstrup DM. The elevated-rim acetabular liner in total hip arthroplasty: relationship to postoperative dislocation. J Bone Joint Surg Am. 1996;78:80–86.PubMedGoogle Scholar
  14. 14.
    Cobb TK, Morrey BF, Ilstrup DM. Effect of the elevated-rim acetabular liner on loosening after total hip arthroplasty. J Bone Joint Surg Am. 1997;79:1361–1364.PubMedGoogle Scholar
  15. 15.
    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
  16. 16.
    Coventry MB. Late dislocations in patients with Charnley total hip arthroplasty. J Bone Joint Surg Am. 1985;67:832–841.PubMedGoogle Scholar
  17. 17.
    Daly PJ, Morrey BF. Operative correction of an unstable total hip arthroplasty. J Bone Joint Surg Am. 1992;74:1334–1343.PubMedGoogle Scholar
  18. 18.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  19. 19.
    Dorr LD, Wan Z. Causes of and treatment protocol for instability of total hip replacement. Clin Orthop Relat Res. 1998;355:144–151.PubMedCrossRefGoogle Scholar
  20. 20.
    Dorr LD, Wolf AW, Chandler R, Conaty JP. Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res. 1983;173:151–158.PubMedGoogle Scholar
  21. 21.
    Earll MD, Fehring TK, Griffin WL, Mason JB, McCoy T, Odum S. Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplasty. 2002;17:864–869.PubMedCrossRefGoogle Scholar
  22. 22.
    Ekelund A. Trochanteric osteotomy for recurrent dislocation of total hip arthroplasty. J Arthroplasty. 1993;8:629–632.PubMedCrossRefGoogle Scholar
  23. 23.
    Engh CA, Massin P, Suthers KE. Roentgenographic assessment of the biologic fixation of porous-surfaced femoral components. Clin Orthop Relat Res. 1990;257:107–128.PubMedGoogle Scholar
  24. 24.
    Etienne G, Ragland PS, Mont MA. Use of constrained acetabular liners in total hip arthroplasty. Orthopedics. 2005;28:463–469; quiz 470–471.Google Scholar
  25. 25.
    Farizon F, de Lavison R, Azoulai JJ, Bousquet G. Results with a cementless alumina-coated cup with dual mobility: a twelve-year follow-up study. Int Orthop. 1998;22:219–224.PubMedCrossRefGoogle Scholar
  26. 26.
    Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of total hip instability with a constrained acetabular component. Clin Orthop Relat Res. 1998;355:171–181.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedGoogle Scholar
  28. 28.
    Guyen O, Chen QS, Bejui-Hugues J, Berry DJ, An KN. Unconstrained tripolar hip implants: effect on hip stability. Clin Orthop Relat Res. 2007;455:202–208.PubMedCrossRefGoogle Scholar
  29. 29.
    Guyen O, Lewallen DG, Cabanela ME. Modes of failure of Osteonics constrained tripolar implants: a retrospective analysis of forty-three failed implants. J Bone Joint Surg Am. 2008;90:1553–1560.PubMedCrossRefGoogle Scholar
  30. 30.
    Guyen O, Pibarot V, Vaz G, Chevillotte C, Carret JP, Bejui-Hugues J. Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation. J Arthroplasty. 2007;22:849–858.PubMedCrossRefGoogle Scholar
  31. 31.
    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
  32. 32.
    Kaplan SJ, Thomas WH, Poss R. Trochanteric advancement for recurrent dislocation after total hip arthroplasty. J Arthroplasty. 1987;2:119–124.PubMedCrossRefGoogle Scholar
  33. 33.
    Kristiansen B, Jorgensen L, Holmich P. Dislocation following total hip arthroplasty. Arch Orthop Trauma Surg. 1985;103:375–377.PubMedCrossRefGoogle Scholar
  34. 34.
    Lavigne MJ, Sanchez AA, Coutts RD. Recurrent dislocation after total hip arthroplasty: treatment with an Achilles tendon allograft. J Arthroplasty. 2001;16(suppl 1):13–18.PubMedCrossRefGoogle Scholar
  35. 35.
    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
  36. 36.
    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
  37. 37.
    Lind M, Krarup N, Petersen LG, Mikkelsen S, Horlyck E. Acetabular revision for recurrent dislocations: results in 14 cases after 3 years of follow-up. Acta Orthop Scand. 2002;73:291–294.PubMedCrossRefGoogle Scholar
  38. 38.
    Lombardi AV Jr, Mallory TH, Kraus TJ, Vaughn BK. Preliminary report on the S-ROM constraining acetabular insert: a retrospective clinical experience. Orthopedics. 1991;14:297–303.PubMedGoogle Scholar
  39. 39.
    Loudon JR, Charnley J. Subsidence of the femoral prosthesis in total hip replacement in relation to the design of the stem. J Bone Joint Surg Br. 1980;62:450–453.PubMedGoogle Scholar
  40. 40.
    Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.PubMedCrossRefGoogle Scholar
  41. 41.
    McCollum DE, Gray WJ. Dislocation after total hip arthroplasty: causes and prevention. Clin Orthop Relat Res. 1990;261:159–170.PubMedGoogle Scholar
  42. 42.
    McGann WA, Welch RB. Treatment of the unstable total hip arthroplasty using modularity, soft tissue, and allograft reconstruction. J Arthroplasty. 2001;16(suppl 1):19–23.PubMedCrossRefGoogle Scholar
  43. 43.
    Mogensen B, Arnason H, Jonsson GT. Socket wall addition for dislocating total hip: report of two cases. Acta Orthop Scand. 1986;57:373–374.PubMedCrossRefGoogle Scholar
  44. 44.
    Morrey BF. Instability after total hip arthroplasty. Orthop Clin North Am. 1992;23:237–248.PubMedGoogle Scholar
  45. 45.
    Morrey BF. Results of reoperation for hip dislocation: the big picture. Clin Orthop Relat Res. 2004;429:94–101.PubMedCrossRefGoogle Scholar
  46. 46.
    Olerud S, Karlstrom G. Recurrent dislocation after total hip replacement: treatment by fixing an additional sector to the acetabular component. J Bone Joint Surg Br. 1985;67:402–405.PubMedGoogle Scholar
  47. 47.
    Parvizi J, Morrey BF. Bipolar hip arthroplasty as a salvage treatment for instability of the hip. J Bone Joint Surg Am. 2000;82:1132–1139.PubMedGoogle Scholar
  48. 48.
    Ries MD, Wiedel JD. Bipolar hip arthroplasty for recurrent dislocation after total hip arthroplasty: a report of three cases. Clin Orthop Relat Res. 1992;278:121–127.PubMedGoogle Scholar
  49. 49.
    Robbins GM, Masri BA, Garbuz DS, Greidanus N, Duncan CP. Treatment of hip instability. Orthop Clin North Am. 2001;32:593–610, viii.Google Scholar
  50. 50.
    Shapiro GS, Weiland D, Sculco TP, Padgett DE, Pellicci PM. The use of a constrained acetabular component for recurrent dislocation. Instr Course Lect. 2001;50:281–287.PubMedGoogle Scholar
  51. 51.
    Shapiro GS, Weiland DE, Markel DC, Padgett DE, Sculco TP, Pellicci PM. The use of a constrained acetabular component for recurrent dislocation. J Arthroplasty. 2003;18:250–258.PubMedCrossRefGoogle Scholar
  52. 52.
    Shrader MW, Parvizi J, Lewallen DG. The use of a constrained acetabular component to treat instability after total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2179–2183.PubMedGoogle Scholar
  53. 53.
    Soong M, Rubash HE, Macaulay W. Dislocation after total hip arthroplasty. J Am Acad Orthop Surg. 2004;12:314–321.PubMedGoogle Scholar
  54. 54.
    Stromsoe K, Eikvar K. Fascia lata plasty in recurrent posterior dislocation after total hip arthroplasty. Arch Orthop Trauma Surg. 1995;114:292–294.PubMedCrossRefGoogle Scholar
  55. 55.
    Toomey SD, Hopper RH Jr, McAuley JP, Engh CA. Modular component exchange for treatment of recurrent dislocation of a total hip replacement in selected patients. J Bone Joint Surg Am. 2001;83:1529–1533.PubMedGoogle Scholar
  56. 56.
    Tufescu TV, Dust W. Failure of a new constrained acetabular insert: a report of 2 cases. J Arthroplasty. 2004;19:238–239.PubMedCrossRefGoogle Scholar
  57. 57.
    Watson P, Nixon JR, Mollan RA. A prosthesis augmentation device for the prevention of recurrent hip dislocation: a preliminary report. Clin Orthop Relat Res. 1991;267:79–84.PubMedGoogle Scholar
  58. 58.
    Weber M, Berry DJ. Abductor avulsion after primary total hip arthroplasty: results of repair. J Arthroplasty. 1997;12:202–206.PubMedCrossRefGoogle Scholar
  59. 59.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.PubMedGoogle Scholar
  60. 60.
    Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplasty. 2005;20:536–541.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Olivier Guyen
    • 1
    • 2
    Email author
  • Vincent Pibarot
    • 1
  • Gualter Vaz
    • 1
  • Christophe Chevillotte
    • 1
  • Jacques Béjui-Hugues
    • 1
  1. 1.Département de Chirurgie OrthopédiqueHôpital Edouard Herriot, Pavillon TLyon Cedex 03France
  2. 2.Laboratoire de Biomécanique des Chocs, LBMC–INRETS URMT 9406Université Claude BernardLyonFrance

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