Abstract
Though dual mobility cups have gained growing popularity as a solution for instability in total hip replacements, these promising devices are subject to a specific implant failure mode, named intraprosthetic dislocation. We present the case of a patient sustaining such an adverse event. The planned revision surgery was postponed 12 months due to a severe heart condition, allowing a rare opportunity to document the natural history of this unusual complication. The small femoral head was found dislodged in the superior part of the metallic shell and had remarkably lost its sphericity. Severe metallic debris and granuloma were found in the proximal femoral region, associated with major periprosthetic bony and soft tissue damage. Surgeons, radiologists, and general practitioners should be aware of this specific complication, its incidence (almost 5 %) and mechanisms (femoral neck to mobile polyethylene insert impingement, leading to rim fatigue and wear of the insert at the capturing area). Diagnosis is mainly based on anteroposterior and modified Lowenstein lateral radiographs of the hip, as an eccentric position of the small femoral head, lying against the concave inner surface of the shell. Prompt component revision should be planned, since delayed management could lead to severe irretrievable damages.
References
Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am. 2004;86-A(1):9–14.
Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA. Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg Br. 2009;91(3):321–6.
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.
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;94:731–9.
Boyer B, Philippot R, Geringer J, Farizon F. Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips. Int Orthop. 2012;36:511–8.
Godefroy D, Chevrot A, Morvan G, Rousselin B, Sarazin L. Plain films of pelvis. J Radiol. 2008;89(5 Pt 2):679–90 [article in French].
Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res. 2010;468:3248–54.
Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, et al. Survival of dual mobility socket with a mean 17 years follow-up [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:43–8.
Philippot R, Boyer B, Farizon F. Intraprosthetic dislocation: a specific complication of the dual-mobility system. Clin Orthop Relat Res. 2013;471(3):965–70.
Loubignac F, Felts E, Allal R. Early intraprosthetic dislocation of a total hip replacement with dual mobility socket: clinical presentation and update review. Eur J Orthop Surg Traumatol. 2012;22(1):S85–7.
Banzhof JA, Robbins CE, Ven AV, Talmo CT, Bono JV. Femoral head dislodgement complicating use of a dual mobility prosthesis for recurrent instability. J Arthroplasty. 2013;28(3):543. e1–3.
Mohammed R, Cnudde P. Severe metallosis owing to intraprosthetic dislocation in a failed dual-mobility cup primary total hip arthroplasty. J Arthroplasty. 2012;27(3):493. e1–3.
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The authors declare that they have no conflicts of interest related to this study.
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Langlois, J., El Hage, S. & Hamadouche, M. Intraprosthetic dislocation: a potentially serious complication of dual mobility acetabular cups. Skeletal Radiol 43, 1013–1016 (2014). https://doi.org/10.1007/s00256-014-1824-7
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DOI: https://doi.org/10.1007/s00256-014-1824-7