Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 1932–1940

Fixation Failures of Dual Mobility Cups: A Mid-term Study of 2601 Hip Replacements

  • Philippe Massin
  • Vincent Orain
  • Rémi Philippot
  • Frederic Farizon
  • Michel Henry Fessy
Clinical Research



The use of dual-mobility cups has increased because of a low rate of dislocations combined with a 96% 15-year survival rate. However, late cup migrations have been attributed to their fixation (tripod - exact fit with two pegs and one extraacetabular screw) and the absence of porous coating. In a second-generation device, the designs were modified to achieve press-fit fixation and a layer of titanium beads was sintered on stainless steel cups.


We therefore (1) determined the midterm survival of press-fit, grit-blasted, second-generation cups with or without additional screws, compared with original tripod and (2) compared survival of grit-blasted dual-mobility cups with bimetallic porous-coated cups.


From a multiinstitutional trial, we reviewed 2408 patients with osteoarthritis implanted with 2601 prostheses of seven designs of a second-generation dual-mobility cup. The criteria for failure were migration, widening radiolucencies in any zone of the interface, or revision for cup loosening. The minimum followup was 5 years (mean, 7.7 years; range, 5–11 years).


The 8-year survival rate of press-fit, grit-blasted cups was lower than that for press-fit, grit-blasted cups fixed with screws (91% versus 100%) and for tripod fixation (98%). The 8-year survival rate of press-fit, grit-blasted cups was less than that for press-fit, porous-coated cups made of the same alloy (91% versus 95%).


The data suggested primary fixation of grit-blasted dual-mobility cups should be secured with screws. Porous coating sintered on the convex side improved midterm survivorship. No deleterious effect of metallosis resulted from sintered titanium beads on stainless steel. Long-term followup is required to confirm these findings.

Level of Evidence

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


  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.PubMedCrossRefGoogle Scholar
  2. 2.
    Bland JM, Altman DG. Survival probabilities (the Kaplan-Meier method). BMJ. 1998; 317:1572.PubMedCrossRefGoogle Scholar
  3. 3.
    Bohm P, Bosche R. Survival analysis of the Harris-Galante I acetabular cup. J Bone Joint Surg Br. 1998;80:396–403.PubMedCrossRefGoogle Scholar
  4. 4.
    Bojescul JA, Xenos JS, Callaghan JJ, Savory CG. Results of porous-coated anatomic total hip arthroplasty without cement at fifteen years: a concise follow-up of a previous report. J Bone Joint Surg Am. 2003;85:1079–1083.PubMedGoogle Scholar
  5. 5.
    Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br. 1972;54:61–76.PubMedGoogle Scholar
  6. 6.
    Cotogno G, Holzwarth U, Franchi M, Rivetti S, Chiesa R. Tribological characterization of surface-treated commercially pure titanium for femoral heads in total hip replacement: a feasibility study. Int J Artif Organs. 2006;29:1174–1184.PubMedGoogle Scholar
  7. 7.
    D’Lima DD, Yashar AA, Venn-Watson EJ, Colwell CW Jr, Walker RH. The Harris-Galante Porous acetabular component at intermediate follow-up. Orthopedics. 2001;24:747–751.PubMedGoogle Scholar
  8. 8.
    DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.PubMedGoogle Scholar
  9. 9.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–213.PubMedCrossRefGoogle Scholar
  10. 10.
    Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. JAMA. 1961;178:261–266.PubMedCrossRefGoogle Scholar
  11. 11.
    Engh CA, Hopper RH Jr, Engh CA Jr. Long-term porous-coated cup survivorship using spikes, screws, and press-fitting for initial fixation. J Arthroplasty. 2004;19(7 suppl 2):54–60.PubMedCrossRefGoogle Scholar
  12. 12.
    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
  13. 13.
    Garavaglia G, Lubbeke A, Barea C, Roussos C, Peter R, Hoffmeyer P. Ten-year results with the Morscher press-fit cup: an uncemented, non-modular, porous-coated cup inserted without screws. Int Orthop. 2011;35:957–963.PubMedCrossRefGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    Kim SY, Kim DH, Kim YG, Oh CW, Ihn JC. Early failure of hemispheric hydroxyapatite-coated acetabular cups. Clin Orthop Relat Res. 2006;446:233–238.PubMedCrossRefGoogle Scholar
  16. 16.
    Lai KA, Shen WJ, Chen CH, Yang CY, Hu WP, Chang GL. Failure of hydroxyapatite-coated acetabular cups: ten-year follow-up of 85 Landos Atoll arthroplasties. J Bone Joint Surg Br. 2002;84:641–646.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Leclercq S, Benoit JY, de Rosa JP, Euvrard P, Leteurtre C, Girardin P. [Results of the Evora dual mobility socket: five years follow-up][in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:37–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Malchau H, Karrholm J, Wang YX, Herberts P. Accuracy of migration analysis in hip arthroplasty: digitized and conventional radiography, compared to radiostereometry in 51 patients. Acta Orthop Scand. 1995;66:418–424.PubMedCrossRefGoogle Scholar
  20. 20.
    Malchau H, Wang YX, Karrholm J, Herberts P. Scandinavian multicenter porous coated anatomic total hip arthroplasty study: clinical and radiographic results with 7- to 10-year follow-up evaluation. J Arthroplasty. 1997;12:133–148.PubMedCrossRefGoogle Scholar
  21. 21.
    Manley MT, Capello WN, D’Antonio JA, Edidin AA, Geesink RG. Fixation of acetabular cups without cement in total hip arthroplasty: a comparison of three different implant surfaces at a minimum duration of follow-up of five years. J Bone Joint Surg Am. 1998;80:1175–1185.PubMedGoogle Scholar
  22. 22.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.PubMedGoogle Scholar
  23. 23.
    Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.PubMedCrossRefGoogle Scholar
  24. 24.
    Miyakawa S, Kawamura H, Mishima H, Yasumoto J. Grit-blasted and hydroxyapatite-coated total hip arthroplasty: an 11- to 14-year follow-up study. J Orthop Sci. 2004;9:462–467.PubMedCrossRefGoogle Scholar
  25. 25.
    Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV, Mantel N, McPherson K, Peto J, Smith PG. Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. analysis and examples. Br J Cancer. 1977;35:1–39.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Reikeras O, Gunderson RB. Failure of HA coating on a gritblasted acetabular cup: 155 patients followed for 7-10 years. Acta Orthop Scand. 2002;73:104–108.PubMedCrossRefGoogle Scholar
  29. 29.
    Vicente JR, Ulhoa CA, Katz M, Addeo RD, Croci AT. A comparative study of “plasmacup” and “porous-coated” acetabular components: survival after 10 to 12 years of follow-up. Clinics (Sao Paulo). 2010;65:1111–1114.CrossRefGoogle Scholar
  30. 30.
    Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C. The dual mobility socket concept: experience with 668 cases. Int Orthop. 2011;35:225–230.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Philippe Massin
    • 1
  • Vincent Orain
    • 2
  • Rémi Philippot
    • 3
  • Frederic Farizon
    • 3
  • Michel Henry Fessy
    • 4
  1. 1.Department of Orthopaedic Surgery, Bichat Claude Bernard HospitalParis Diderot UniversityParis Cedex 18France
  2. 2.Department of Orthopaedic SurgeryAngers HospitalAngersFrance
  3. 3.Department of Orthopaedic SurgeryCentre hospitalier universitaire de Saint EtienneSaint EtienneFrance
  4. 4.Department of Orthopaedic SurgeryCentre Hospitalier Lyon SudPierre-BéniteFrance

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