Introduction: Large-diameter metal-on-metal (LDMOM) cups have been used in total hip arthroplasty (THA) advocating superior results with respect to dislocation rates, range of motion, and long-term survival. The Durom cup used as part of the Durom hip resurfacing system has been incriminated with poor short-term results sometimes correlated to incorrect positioning of either the femoral or acetabular component due to poor exposure during this procedure. Our objective was to evaluate short-term results of the Durom cup used in conjunction with standard stems.
Methods: We prospectively followed all patients with a large-diameter metal-on-metal articulation (Durom) and a standard stem operated upon between 9/2004 and 9/2008. Patients were seen at follow-up for a clinical (Harris hip score (HHS), University College of Los Angeles (UCLA) scale, Visual Analogue Scale (VAS), and patient satisfaction), radiographic, and questionnaire assessment.
Results: Eighty-nine primary THAs in 80 patients (74% men) with a mean age of 52 (±12) years were included. Main diagnoses were primary osteoarthritis in 47% and aseptic necrosis in 35%. An uncemented stem was used in 79%. Overall, 80 THAs were controlled at a mean follow-up of 39 months (range, 16–67 months); 4 patients were lost to follow-up, and 5 patients refused or were unable to attend the visit. However, none of the 5 underwent revision. Nine THAs (9/85, 9.4%) were revised in mean 30 months (range, 8–60 months) after the operation. The reasons for revision were aseptic loosening in three cases, presence of a granuloma (histological diagnosis of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)) in four, deep infection in one, and impingement in one case. Radiographic analysis revealed linear (n = 2) and focal (n = 3) osteolysis as well as early cup migration (n = 2). In five of the revised patients, no radiographic changes were found. Fifty-five (69%) of the 80 patients with follow-up had a HHS between 80 and 100. Among those who were not revised, the mean HHS improved from 55.2 to 88.4 (mean increase 33.2, 95% CI 27.7; 38.7). The mean activity level (UCLA scale) at follow-up was 6.4 (±1.8). Overall, mild to severe pain was reported in 14 cases and occasional pain in 22. Groin pain was present in 18 patients (22.5%), 7 of them belonged to the revised group. Sixty-one (76.3%) of the 80 patients with follow-up were satisfied. Mean patient satisfaction on the VAS scale among those who were not revised was 9.0 (±1.3).
Conclusion: This study confirms the increased short-term revision rate of the large-diameter metal-on-metal couple (Durom) reported by others. In all revision cases, the retrieved cups showed no osteo-integration and were removed easily. Radiographic signs of implant loosening were not always present. For most revision cases, the operative indication was based upon groin pain and patient dissatisfaction.
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