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Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability

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Abstract

Purpose

Instability remains as an unsolved complication after revision total hip arthroplasty (rTHA). Dual mobility (DM) cups have decreased dislocation rate in rTHA; however, there are few clinical studies that evaluate the risk of dislocation after rTHA in patients with high risk of instability.

Methods

Between 2007 and 2019, 95 consecutive rTHA using a DM cup, in 93 patients with instability risk factors were retrospectively reviewed. Instability risk factors were defined as follows: deficient abductor mechanism (22.1%), previous dislocation (68.4%), Paprosky 3 acetabular bone defect (21.1%), neuromuscular disease (4.2%), lumbar spine arthrodesis (6.3%), and more than one previous surgery (33.6%). Mean follow-up was 4.3 ± 2.4 years. Clinical and radiographic parameters were reported. DM cup survival was determined using a Kaplan–Meier analysis with re-revision for any cause as the end-point. Surgical complications and re-dislocation rate was recorded.

Results

Seven DM cups were re-revised; three due to aseptic loosening, three due to peri-prosthetic joint infection (PJI), and one due to instability. At seven years follow-up, the survival rate of the DM cup using re-revision for any reason as the end-point was 82.4% (95% confidence interval, 66.4–98.4%). There were 12 (12.6%) complications: two (2.1%) dislocations, six (6.3%) PJI, four (4.2%) peri-prosthetic fractures.

Conclusion

Our findings suggest DM cups are effective reducing dislocation rate in rTHA in patients with a high risk of instability, without increasing early aseptic loosening and with a low rate of dislocation. Nevertheless, longer follow-up is needed to confirm implant stability and dislocation rates in the long term.

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Data availability

The data that support the findings of this study are available from the corresponding author, [JA], upon reasonable request.

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Authors and Affiliations

  1. Hospital Universitario La Paz, Paseo de La Castellana 261, 28046, Madrid, Spain

    Juan Ameztoy Gallego, Ana Cruz Pardos, Javier Gomez Luque, Luis Eduardo Cuadrado Rubio & Ricardo Fernández Fernández

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  1. Juan Ameztoy Gallego
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  2. Ana Cruz Pardos
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  3. Javier Gomez Luque
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Juan Ameztoy Gallego, Ana Cruz Pardos, Javier Gomez Luque, and Luis Eduardo Cuadrado Rubio. The first draft of the manuscript was written by Juan Ameztoy Gallego, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Juan Ameztoy Gallego.

Ethics declarations

Ethics approval

Approval was obtained from the ethics committee of our Institutional Review Board (PI-2626). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Fig. 2a and b.

Fig. 2
figure 2

a A 58-year-old woman with lumbar and right hip arthrodesis after 3 surgeries due to development hip dysplasia. b A revision THA was performed with a cementless dual mobility cup with good outcomes and no dislocation at 6 years of follow-up

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Competing interest

Ana Cruz Pardos has received speaker honoraria from Smith & Nephew PLC and consultant honoraria from Stryker Corporation. All the other authors declare no competing interests.

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Ameztoy Gallego, J., Cruz Pardos, A., Gomez Luque, J. et al. Dislocation and survival rate of dual mobility cups in revision total hip arthroplasty in patients with high risk of instability. International Orthopaedics (SICOT) 47, 1757–1764 (2023). https://doi.org/10.1007/s00264-023-05816-8

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