Skip to main content
Log in

Obesity is no longer a risk factor for dislocation after total hip arthroplasty with a double-mobility cup

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript



Dislocation is one of the most feared complications after total hip arthroplasty (THA). This risk is greater in obese patients compared with the general population.


We performed a retrospective cohort study in which the main objective was to compare the dislocation rate between obese patients (BMI > 30 kg/m²) (exposed group) and non-obese patients (BMI ≤ 30 kg/m²) (unexposed group) after primary THA with a double-mobility acetabular cup. The patients had a minimum follow-up of 24 months.


The ‘obese’ group consisted of 77 THA cases and the ‘non-obese’ group of 425 cases; the two groups were similar in terms of age, gender and ASA score. After a mean follow-up of 58.3 ± 27 months (range 27–159), 43 patients had been lost to follow-up and 56 had died; the two groups had similar mean values. One patient in the ‘obese’ group had suffered a dislocation due to a fall 16 months after the THA. One patient in the ‘non-obese’ group had suffered a dislocation after a periprosthetic femur fracture with stem subsidence two months after the THA procedure. Both patients underwent surgical revision where the double-mobility cup was preserved; there were no further dislocation events as of the last follow-up. The dislocation rate in the two groups was similar (1.3 % versus 0.23 %, p > 0.05). No cases of loosening were found. Revisions were secondary to deep or superficial infection (n = 22), periprosthetic femur fracture (n = 10) or haematoma (n = 3).


These findings imply that double-mobility cups are a reliable way of reducing the risk of dislocation in obese patients after primary THA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. Haidar Y, Cosman B (2011) Obesity epidemiology. Clin Colon Rectal Surg 24:205–210

    Article  PubMed Central  PubMed  Google Scholar 

  2. Tai S, Imbuldeniya A, Munir S, Walter W, Walter W, Zicat B (2014) The effect of obesity on the clinical, functional and radiological outcome of cementless total hip replacement: A case-matched study with a minimum 10-year follow-up. J Arthroplasty 29(9):1758–1762. doi:10.1016/j.arth.2014.04.033 [Epub ahead of print]

  3. Andrew J, Palan J, Kurup H, Gibson P, Murray D, Beard D (2008) Obesity in total hip replacement. J Bone Joint Surg (Br) 90:424–429

    Article  CAS  Google Scholar 

  4. Sanchez-Sotelo J, Berry D (2001) Epidemiology of instability after total hip replacement. Orthop Clin North Am 32:543–552

    Article  CAS  PubMed  Google Scholar 

  5. Kim Y, Choi Y, Kim J (2009) Influence of patient-, design-, and surgery-related factors on rate of dislocation after primary cementless total hip arthroplasty. J Arthroplasty 24:1258–1263

    Article  PubMed  Google Scholar 

  6. Kim Y, Morshed S, Joseph T, Bozic K, Ries M (2006) Clinical impact of obesity on stability following revision total hip arthroplasty. Clin Orthop Relat Res 543:142–146

    Article  Google Scholar 

  7. Chee Y, Teoh K, Sabnis B, Ballantyne J, Brenkel I (2010) Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study. J Bone Joint Surg 92:1066–1071

    Article  CAS  Google Scholar 

  8. Davis A, Wood A, Keenan A, Brenkel I, Ballantyne J (2011) Does body mass index affect clinical outcome post-operatively and at five years after primary unilateral total hip replacement performed for osteoarthritis? a multivariate analysis of prospective data. J Bone Joint Surg 93:1178–1182

    Article  CAS  Google Scholar 

  9. Lubbeke A, Stern R, Garavaglia G, Zurcher L, Hoffmeyer P (2007) Differences in outcomes of obese women and men undergoing primary total hip arthroplasty. Arthritis Rheum 57:327–334

    Article  PubMed  Google Scholar 

  10. Sadr Azodi O, Adami J, Lindstrom D, Eriksson K, Wladis A, Bellocco R (2008) High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2,106 patients followed for up to 8 years. Acta Orthop 79:141–147

    Article  PubMed  Google Scholar 

  11. Guyen O, Pibarot V, Vaz G, Chevillotte C, Bejui-Hugues J (2009) Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res 467:465–472

    Article  PubMed Central  PubMed  Google Scholar 

  12. Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F (2010) The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res 468:3248–3254

    Article  PubMed Central  PubMed  Google Scholar 

  13. Adam P, Philippe R, Ehlinger M, Roche O, Bonnomet F, Mole D, Fessy MH (2012) Dual mobility cups hip arthroplasty as a treatment for displaced fracture of the femoral neck in the elderly. A prospective, systematic, multicenter study with specific focus on postoperative dislocation. Orthop Traumatol Surg Res 98:296–300

    Article  CAS  PubMed  Google Scholar 

  14. Elkins J, Daniel M, Pedersen D, Singh B, Yack H, Callaghan J, Brown T (2013) Morbid obesity may increase dislocation in total hip patients: a biomechanical analysis. Clin Orthop Relat Res 471:971–980

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hayashi S, Nishiyama T, Fujishiro T, Hashimoto S, Kanzaki N, Nishida K, Kurosaka M (2012) Obese patients may have more soft tissue impingement following primary total hip arthroplasty. Int Orthop 36:2419–2423

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ley C, Lees B, Stevenson J (1992) Sex- and menopause-associated changes in body-fat distribution. Am J Clin Nutr 55:950–954

  17. Tomlinson D, Erskine R, Winwood K, Morse C, Onambélé G (2014) Obesity decreases both whole muscle and fascicle strength in young females but only exacerbates the aging-related whole muscle level asthenia. Physiol Rep 2–6

  18. Lerner Z, Board W, Browning R (2014) Effects of obesity on lower extremity muscle function during walking at two speeds. Gait Posture 39:97–84

    Article  Google Scholar 

  19. Philippot R, Boyer B, Farizon F (2013) Intraprosthetic dislocation: a specific complication of the dual-mobility system. Clin Orthop Relat Res 471:965–970

    Article  PubMed Central  PubMed  Google Scholar 

  20. Fresard PL, Alvherne C, Cartier JL, Cuinet P, Lantuejoul JP (2013) Seven-year results of a press-fit, hydroxyapatite-coated double mobility acetabular component in patients aged 65 years or older. Eur J Orthop Surg Traumatol 23:425–429

    Article  PubMed  Google Scholar 

  21. Leclercq S, Benoit JY, de Rosa JP, Euvrard P, Leteurtre C, Girardin P (2008) Results of the Evora dual-mobility socket after a minimum follow-up of five years. Rev Chir Orthop Reparatrice Appar Mot 94:e17–e22

    Article  CAS  PubMed  Google Scholar 

  22. Epinette JA, Beracassat R, Tracol P, Pagazani G, Vandenbussche E (2014) Are modern dual mobility cups a valuable option in reducing instability after primary hip arthroplasty, even in younger patients? J Arthroplasty 29:1323–1328

    Article  PubMed  Google Scholar 

  23. Philippot R, Meucci JF, Boyer B, Farizon F (2013) Modern dual-mobility cup implanted with an uncemented stem: about 100 cases with 12-year follow-up. Surg Technol Int 23:208–212

    PubMed  Google Scholar 

  24. Combes A, Migaud H, Girard J, Duhamel A, Fessy MH (2013) Low rate of dislocation of dual-mobility cups in primary total hip arthroplasty. Clin Orthop Relat Res 471:3891–3900

    Article  PubMed Central  PubMed  Google Scholar 

  25. Farizon F, de Lavison R, Azoulai JJ, Bousquet G (1998) Results with a cementless alumina-coated cup with dual mobility. A twelve-year follow-up study. Int Orthop 22:219–224

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Caton JH, Prudhon JL, Ferreira A, Aslanian T, Verdier R (2014) A comparative and retrospective study of three hundred and twenty primary Charnley type hip replacements with a minimum follow up of ten years to assess wether a dual mobility cup has a decreased dislocation risk. Int Orthop 38:1125–1129

    Article  PubMed Central  PubMed  Google Scholar 

  27. Hamadouche M, Arnould H, Bouxin B (2012) Is a cementless dual mobility socket in primary THA a reasonable option? Clin Orthop Relat Res 470:3048–3053

    Article  PubMed Central  PubMed  Google Scholar 

  28. Prudhon JL (2012) Dual-mobility cup and cemented femoral component: 6 year follow-up results. Hip Int 21:713–717

    Article  Google Scholar 

  29. Boyer B, Philippot R, Geringer J, Farizon F (2012) Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips. Int Orthop 36:511–518

    Article  PubMed Central  PubMed  Google Scholar 

  30. Lautridou C, Lebel B, Burdin G, Vielpeau C (2008) Survival of the cementless Bousquet dual mobility cup: minimum 15-year follow-up of 437 total hip arthroplasties. Rev Chir Orthop Reparatrice Appar Mot 94:731–739

    Article  CAS  PubMed  Google Scholar 

  31. Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F (2008) Survival of dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 94:e23–e27

    Article  CAS  PubMed  Google Scholar 

  32. Philippot R, Camilleri JP, Boyer B, Adam P, Farizon F (2009) 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 33:927–932

    Article  PubMed Central  PubMed  Google Scholar 

  33. Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C (2011) The dual mobility socket concept: experience with 668 cases. Int Orthop 35:225–230

    Article  PubMed Central  PubMed  Google Scholar 

  34. Adam P, Farizon F, Fessy MH (2005) Dual articulation retentive acetabular liners and wear: surface analysis of 40 retrieved polyethylene implants. Rev Chir Orthop Reparatrice Appar Mot 91:627–636

    Article  CAS  PubMed  Google Scholar 

  35. Philippot R, Adam P, Farizon F, Fessy MH, Bousquet G (2006) Survival of cementless dual mobility sockets: ten-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 92:326–331

    Article  CAS  PubMed  Google Scholar 

  36. Bunn A, Colwell C Jr, D’Lima D (2014) Effect of head diameter on passive and active dynamic hip dislocation. J Orthop Res 32(11):1525–1531. doi:10.1002/jor.22659 [Epub ahead of print]

  37. Berend K, Lombardi A Jr, Mallory T, Adams J, Russell J, Groseth K (2005) The long-term outcome of 755 consecutive constrained acetabular components in total hip arthroplasty examining the successes and the failures. J Arthroplasty 20(3):93–102

    Article  PubMed  Google Scholar 

  38. Leclercq S, Benoit JY, de Rosa JP, Tallier E, Leteurtre C, Girardin PH (2013) Evora® chromium-cobalt dual mobility socket: results at a minimum 10 years’ follow-up. Orthop Traumatol Surg Res 99:923–928

    Article  CAS  PubMed  Google Scholar 

  39. Middleton F, Boardman D (2007) Total hip arthroplasty does not aid weight loss. Ann R Coll Surg Engl 89:288–291

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  40. Paans N, Stevens M, Wagenmakers R, van Beveren J, van der Meer K, Bulstra S, van den Akker-Scheek I (2012) Changes in body weight after total hip arthroplasty: short-term and long-term effects. Phys Ther 92:680–687

    Article  PubMed  Google Scholar 

  41. Donovan J, Dingwall I, McChesney S (2006) Weight change 1 year following total knee or hip arthroplasty. ANZ J Surg 76:222–225

    Article  PubMed  Google Scholar 

Download references


The authors are grateful to Joanne Archambault, PhD for her editorial support during preparation of this manuscript.

Conflict of interest

P. Chiron is a consultant for Zimmer, Smith & Nephew and Sanofi, and has received royalties from Zimmer and Integra. Jean Michel Laffosse is a consultant for Tornier and Stryker.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jean-Michel Laffosse.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maisongrosse, P., Lepage, B., Cavaignac, E. et al. Obesity is no longer a risk factor for dislocation after total hip arthroplasty with a double-mobility cup. International Orthopaedics (SICOT) 39, 1251–1258 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: