Clinical Orthopaedics and Related Research®

, Volume 468, Issue 12, pp 3248–3254 | Cite as

The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation

  • Moussa HamadoucheEmail author
  • David J. Biau
  • Denis Huten
  • Thierry Musset
  • François Gaucher
Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society



The treatment of recurrent dislocation after total hip arthroplasty remains challenging. Dual mobility sockets have been associated with a low rate of dislocation but it is not known whether they are useful for treating recurrent dislocation.


We therefore asked whether a cemented dual mobility socket would (1) restore hip stability following recurrent dislocation; (2) provide a pain-free and mobile hip; and (3) show durable radiographic fixation.


We retrospectively reviewed 51 patients treated with a cemented dual mobility socket for recurrent dislocation after total hip arthroplasty between August 2002 and June 2005. The mean age at the time of the index procedure of was 71.3 years. Of the 51 patients, 47 have had complete clinical and radiographic evaluation data at a mean followup of 51.4 months (range, 25–76.3 months).


The cemented dual mobility socket restored complete stability of the hip in 45 of the 47 patients (96%). The mean Merle d’Aubigné hip score was 16 ± 2 at the latest followup. Radiographic analysis revealed no or radiolucent lines less than 1 mm thick located in a single acetabular zone in 43 of 47 hips (91.5%). The cumulative survival rate of the acetabular component at 72 months using revision for dislocation and/or mechanical failure as the end point was 96% ± 4% (95% confidence interval, 90%–100%).


A cemented dual mobility socket was able to restore hip stability in 96% of recurrent dislocating hips. However, longer-term followup is needed to ensure that dislocation and loosening rates will not increase.

Level of Evidence

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


Femoral Head Acetabular Component Radiolucent Line Cumulative Survival Rate Recurrent Dislocation 
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 dedicate this paper to the memory of Frantz Langlais, MD. We thank O. Chaix, MD, and Jean Pierre Courpied, MD, for contributing patients and Nicolas Barba, MD, for help in gathering data.


  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. 2005;91:627–636.PubMedGoogle Scholar
  2. 2.
    Anderson MJ, Murray WR, Skinner HB. Constrained acetabular components. J Arthroplasty. 1994;9:17–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Aubriot J, 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
  4. 4.
    Barrack RL, Mulroy RD, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty. A 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.PubMedGoogle Scholar
  5. 5.
    Berend KR, Lombardi AV, 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.CrossRefPubMedGoogle Scholar
  6. 6.
    Berry DJ. Unstable total hip arthroplasty: detailed overview. Instr Course Lect. 2001;50:265–274.PubMedGoogle Scholar
  7. 7.
    Bousquet G, Gazielly DF, Giradin P, Debiesse JL, Relave M, Israeli A. The ceramic coated cementless total hip arthroplasty. Basic concepts and surgical technique. J Orthop Surg Tech. 1985;1:15–28.Google Scholar
  8. 8.
    Cates HE, Faris PM, Keating EM, Ritter MA. Polyethylene wear in cemented metal-backed acetabular cups. J Bone Joint Surg Br. 1993;75:249–253.PubMedGoogle Scholar
  9. 9.
    Chandler RW, Dorr LD, Perry J. The functional cost of dislocation following total hip arthroplasty. Clin Orthop Relat Res. 1982;168:168–172.PubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    Daly PJ, Morrey BF. Operative correction of an unstable total hip arthroplasty. J Bone Joint Surg Am. 1992;74:1334–1343.PubMedGoogle Scholar
  12. 12.
    De Lee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.Google Scholar
  13. 13.
    Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplasty. 2005;20(Suppl 3):103–107.CrossRefPubMedGoogle Scholar
  14. 14.
    Farizon F, de LR, 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.CrossRefPubMedGoogle Scholar
  15. 15.
    Fisher DA, Kiley K. Constrained acetabular cup disassembly. J Arthroplasty. 1994;9:325–329.CrossRefPubMedGoogle Scholar
  16. 16.
    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. A concise follow-up of a previous report. J Bone Joint Surg Am. 2004;86:2419–2423.PubMedGoogle Scholar
  17. 17.
    Goetz DD, Capello WN, Callaghan JJ, Brown TD, Johnston RC. Salvage of a recurrently dislocating total hip prosthesis with use of a constrained acetabular component. A retrospective analysis of fifty-six cases. J Bone Joint Surg Am. 1998;80:502–509.PubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Guyen O, Pibarot V, Vaz G, Chevillotte C, Bejui-Hugues J. Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res. 2009;467:465–472.CrossRefPubMedGoogle Scholar
  22. 22.
    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 Arthroplast. 2007;22:849–58.Google Scholar
  23. 23.
    Harris WH, Penenberg BL. Further follow-up on socket fixation using a metal-backed acetabular component for total hip replacement. A minimum ten-year follow-up study. J Bone Joint Surg Am. 1987;69:1140–1143.PubMedGoogle Scholar
  24. 24.
    Kaper BP, Bernini PM. Failure of a constrained acetabular prosthesis of a total hip arthroplasty. A report of four cases. J Bone Joint Surg Am. 1998;80:561–565.PubMedGoogle Scholar
  25. 25.
    Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res. 2000;378:155–168.CrossRefPubMedGoogle Scholar
  26. 26.
    Khan RJ, Fick D, Alakeson R, Haebich S, de Cruz M, Nivbrant B, Wood D. A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br. 2006;88:870–876.CrossRefPubMedGoogle Scholar
  27. 27.
    Krein SW, Chao EY. Biomechanics of bipolar hip endoprostheses. J Orthop Res. 1984;4:356–368.CrossRefGoogle Scholar
  28. 28.
    Langlais F, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res. 2008;466:389–395.CrossRefPubMedGoogle Scholar
  29. 29.
    Lautridou C, Lebel B, Burdin G, Vielpeau C. Survival of the cementless Bousquet dual mobility cup: Minimum 15-year follow-up of 437 total hip arthroplasties [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:731–739.PubMedGoogle Scholar
  30. 30.
    Leclercq S, El Bidi 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
  31. 31.
    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.Google Scholar
  32. 32.
    Lombardi AV, 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
  33. 33.
    Mantel N, Haenzel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.PubMedGoogle Scholar
  34. 34.
    McCarthy JC, Lee JA. Constrained acetabular components in complex revision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:210–215.CrossRefPubMedGoogle Scholar
  35. 35.
    Merle d’aubigné R. Numerical classification of the function of the hip [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1970;56:481–486.Google Scholar
  36. 36.
    Murray DW, Carr AJ, Bulstrode C. Survival analysis of joint replacements. J Bone Joint Surg Br. 1993;75:697–704.PubMedGoogle Scholar
  37. 37.
    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
  38. 38.
    Philippot R, Adam P, Reckhaus M, Delangle F, Verdot FX, Curvale G, Farizon F. Prevention of dislocation in total hip revision surgery using a dual mobility design [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2009;95:407–413.Google Scholar
  39. 39.
    Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F. 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. Int Orthop. 2009;33:927–932.CrossRefPubMedGoogle Scholar
  40. 40.
    Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F. Survival of dual mobility socket with a mean 17 years follow-up [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:43–48.PubMedGoogle Scholar
  41. 41.
    Ritter MA. The cemented acetabular component of a total hip replacement. All polyethylene versus metal backing. Clin Orthop Relat Res. 1995;311:69–75.Google Scholar
  42. 42.
    Sanchez-Sotelo J, Berry DJ. Epidemiology of instability after total hip replacement. Orthop Clin North Am. 2001;32:543–552, vii.Google Scholar
  43. 43.
    Sanchez-Sotelo J, Haidukewych GJ, Boberg C. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2006;88:290–294.CrossRefPubMedGoogle Scholar
  44. 44.
    Shapiro G, Weiland D, Markel D, Padgett D, Sculco T, Pellicci P. The use of a constrained acetabular component for recurrent dislocation. J Arthroplasty. 2003;18:250–258.CrossRefPubMedGoogle Scholar
  45. 45.
    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
  46. 46.
    Su EP, Pellicci PM. The role of constrained liners in total hip arthroplasty. Clin Orthop Relat Res. 2004;420:122–129.CrossRefPubMedGoogle Scholar
  47. 47.
    Tufescu TV, Dust W. Failure of a new constrained acetabular insert: a report of 2 cases. J Arthroplasty. 2004;19:238–239. CrossRefPubMedGoogle Scholar
  48. 48.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.PubMedGoogle Scholar
  49. 49.
    Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplasty. 2005;20:536–541.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Moussa Hamadouche
    • 1
    Email author
  • David J. Biau
    • 1
  • Denis Huten
    • 2
  • Thierry Musset
    • 3
  • François Gaucher
    • 4
  1. 1.The Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Service A, Centre Hospitalo-Universitaire Cochin-Port RoyalUniversité René Descartes, Hôpital Cochin (AP-HP)ParisFrance
  2. 2.Department of Orthopaedic Surgery and TraumatologyUniversity HospitalRennesFrance
  3. 3.The Clinique du TerPloemeurFrance
  4. 4.The Centre Hospitalier de Pont l’AbbéPont l’AbbéFrance

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