Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting.
Materials and methods
This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months.
Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed.
The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.
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Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ (2015) Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473(6):2131–2138
Kärrholm J, Garellick G, Herberts P (2005) The Swedish hip arthroplasty register. Annu Rep 2005 Available at: http://www.jru.orthop.gu.se
Alberton GM, High WA, Morrey BF (2002) Dislocation after revision total hip arthroplasty: an analysis of risk factors and treatment options. J Bone Joint Surg Am 84(10):1788–1792
Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty: prevention and treatment. J Arthroplast 22(4 Suppl 1):86–90
Yun AG, Padgett D, Pellicci P, Dorr LD (2005) Constrained acetabular liners: mechanisms of failure. J Arthroplast 20(4):536–541
Williams JT Jr, Ragland PS, Clarke S (2007) Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop 31(3):273–277
Bousquet G, Gazielly D, Girardin P, Debiesse JL, Relave M, Israeli A (1985) The ceramic coated cementless total hip arthroplasty. Basic concepts and surgical technique. J Orthop Surg 1:15–28
Bouchet R, Mercier N, Saragaglia D (2011) Posterior approach and dislocation rate: a 213 total hip replacements case-control study comparing the dual mobility cup with a conventional 28-mm metal head/polyethylene prosthesis. Orthop Traumatol Surg Res 97(1):2–7
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(3):511–518
Assi C, El-Najjar E, Samaha C, Yammine K (2017) Outcomes of dual mobility cups in a young Middle Eastern population and its influence on life style. Int Orthop 41(3):619–624
Assi C, Kheir N, Samaha C, Kouyoumjian P, Yammine K (2018) Early results of total hip arthroplasty using dual-mobility cup in patients with osteonecrosis of the femoral head. SICOT-J 4:4.
Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O (2008) Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res 466(2):389–395
Philippot R, Adam P, Reckhaus M, Delangle F, Verdot F, Curvale G, Farizon F (2009) Prevention of dislocation in total hip revision surgery using a dual mobility design. Orthop Traumatol Surg Res 95(6):407–413
Girard J, Combes A, Herent S, Migaud H (2011) Metal-on-metal cups cemented into reinforcement rings: a possible new acetabular reconstruction procedure for young and active patients. J Arthroplast 26:103–109
Kerboull M, Hamadouche M, Kerboull L (2000) The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res 378:155–168
Kawai T, Tanaka C, Ikenaga M, Kanoe H, Okudaira S (2010) Total hip arthroplasty using Kerboull-type acetabular reinforcement device for rapidly destructive coxarthrosis. J Arthroplast 25:432–436
Okano K, Miyata N, Enomoto H, Osaki M, Shindo H (2010) Revision with impacted bone allografts and the Kerboull cross-plate for massive bone defect of the acetabulum. J Arthroplast 25:594–599
Lunn JV, Kearns SS, Quinlan W, Murray P, Byrne JO (2005) Impaction allografting and the Kerboull acetabular reinforcement device: 35 hips followed for 3—7 years. Acta Orthop 76:296–302
Schneider L, Philippot R, Boyer B, Farizon F (2011) Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res 97(8):807–813
Pattyn C, Audenaert E (2012) Early complications after revision total hip arthroplasty with cemented dual-mobility socket and reinforcement ring. Acta Orthop Belg 78(3):357–361
Vasukutty NL, Middleton RG, Matthews EC, Young PS, Uzoigwe CE, Minhas TH (2012) The double-mobility acetabular component in revision total hip replacement: the United Kingdom experience. J Bone Joint Surg (Br) 94(5):603–608
Wegrzyn J, Pibarot V, Jacquel A, Carret JP, Béjui-Hugues J, Guyen O (2014) Acetabular reconstruction using a Kerboull cross-plate, structural allograft and cemented dual-mobility cup in revision THA at a minimum 5-year follow-up. J Arthroplast 29(2):432–437
Assi C, Caton J, Aslanian T, Samaha C, Yammine K (2018) The cross technique for the positioning of Kerboull plate in acetabular reconstruction surgery. SICOT-J 4:20
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement : incidence and a method of classification. J Bone Joint Surg Am 55:1629
Grodet H, Maisse N, Fodzo E, Caillon F, Quiennec C (2006) Evaluation de l’incorporation des greffons en pratique clinique. In: Groupe Integra (ed) La reprise totale de hanche, Sauramps Medical, France, pp 251–256
Batailler C, Fary C, Verdier R, Aslanian T, Caton J, Lustig S (2017) The evolution of outcomes and indications for the dual-mobility cup: a systematic review. Int Orthop 41(3):645–659
Viste A, Desmarchelier R, Fessy MH (2017) Dual mobility cups in revision total hip arthroplasty. Int Orthop 41(3):535–542
Stucinskas J, Kalvaitis T, Smailys A, Robertsson O, Tarasevicius S (2018) Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations: five year results from Lithuanian arthroplasty register. Int Orthop 42(5):1015–1020
Garbuz D, Morsi E, Gross AE (1996) Revision of the acetabular component of a total hip arthroplasty with a massive structural allograft. Study with a minimum five-year follow-up. J Bone Joint Surg Am 78(5):693–697
Pieringer H, Auersperg V, Böhler N (2006) Reconstruction of severe acetabular bone-deficiency: the Burch-Schneider antiprotrusio cage in primary and revision total hip arthroplasty. J Arthroplast 21(4):489–496
Winter E, Piert M, Volkmann R, Maurer F, Eingartner C, Weise K, Weller S (2001) Allogeneic cancellous bone graft and a Burch-Schneider ring for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Am 83(6):862–867
Ulrich SD, Seyler TM, Bennett D, Delanois RE, Saleh KJ, Thongtrangan I, Kuskowski M, Cheng EY, Sharkey PF, Parvizi J, Stiehl JB, Mont MA (2008) Total hip arthroplasties: what are the reasons for revision? Int Orthop 32(5):597–604
Mi R, Grassi A, Costa GG, Lazaro LE, Lo Presti M, Zaffagnini S (2018) The efficacy of dual-mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and meta-analysis of comparative studies. Int Orthop. https://doi.org/10.1007/s00264-018-4062-0
Hernigou P, Auregan JC, Potage D, Roubineau F, Flouzat Lachaniette CH, Dubory A (2017) Dual-mobility implants prevent hip dislocation following hip revision in obese patients. Int Orthop 41(3):469–473
Prudhon JL, Desmarchelier R, Hamadouche M, Delaunay C, Verdier R, SoFCOT (2017) Causes for revision of dual-mobility and standard primary total hip arthroplasty: matched case-control study based on a prospective multicenter study of two thousand and forty four implants. Int Orthop 41(3):455–459
Caton JH, Ferreira A (2017) Dual-mobility cup: a new French revolution. Int Orthop 41(3):433–437
Mohaddes M, Cnudde P, Rolfson O, Wall A, Kärrholm J (2017) Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. Int Orthop 41(3):583–588
Noyer D, Caton JH (2017) Once upon a time.... dual mobility: history. Int Orthop 41(3):611–618
Neri T, Boyer B, Geringer J, Di Iorio A, Caton JH, PhiIippot R, Farizon F (2018) Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring? Int Orthop. https://doi.org/10.1007/s00264-018-4054-0
Aslanian T (2017) All dual mobility cups are not the same. Int Orthop 41(3):573–581
Hernigou P, Dubory A, Potage D, Roubineau F, Flouzat Lachaniette CH (2017) Dual-mobility arthroplasty failure: a rationale review of causes and technical considerations for revision. Int Orthop 41(3):481–490
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(4):927–932
Conflict of interest
Assi and Caton declare royalties from Lepine Group. Fawaz, Samaha, and Yammine have no financial statement to declare.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
For this type of study, formal consent is not required.
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Assi, C., Caton, J., Fawaz, W. et al. Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups. International Orthopaedics (SICOT) 43, 2245–2251 (2019). https://doi.org/10.1007/s00264-018-4209-z
- Total hip arthroplasty
- Revision total hip arthroplasty
- Dual mobility