Total Hip Arthroplasty with a Large-Diameter Metal-on-Metal Cup (Durom) and a Standard Stem: Short-Term Results

  • Panayiotis Christofilopoulos
  • Anne Lübbeke
  • Charles Berton
  • Alexandre Lädermann
  • Martin Berli
  • Constantinos Roussos
  • Alexis Bonvin
  • Robin Peter
  • Pierre Hoffmeyer


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.


Acetabular Component Groin Pain Primary THAs Visual Analogue Scale Scale High Revision Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Beaule PE, Dorey FJ et al (2006) The value of patient activity level in the outcome of total hip arthroplasty. J Arthroplasty 21(4):547–552PubMedCrossRefGoogle Scholar
  2. 2.
    Berton C, Girard J et al (2010) The Durom large diameter head acetabular component: early results with a large-diameter metal-on-metal bearing. J Bone Joint Surg Br 92(2):202–208PubMedCrossRefGoogle Scholar
  3. 3.
    Brooker AF, Bowerman JW et al (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632PubMedGoogle Scholar
  4. 4.
    Crowninshield RD, Maloney WJ et al (2004) Biomechanics of large femoral heads: what they do and don’t do. Clin Orthop Relat Res 429:102–107PubMedCrossRefGoogle Scholar
  5. 5.
    Daou S, El Chemaly A et al (2011) The potential role of cobalt ions released from metal ­prosthesis on the inhibition of Hv1 proton channels and the decrease in Staphylococcus epidermidis killing by human neutrophils. Biomaterials 32(7):1769–1777PubMedCrossRefGoogle Scholar
  6. 6.
    Davies AP, Willert HG et al (2005) An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am 87(1):18–27PubMedCrossRefGoogle Scholar
  7. 7.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32PubMedGoogle Scholar
  8. 8.
    Engh CA, Bobyn JD et al (1987) Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg Br 69(1):45–55PubMedGoogle Scholar
  9. 9.
    Gruen TA, McNeice GM et al (1979) “Modes of failure” of cemented stem-type femoral ­components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27PubMedGoogle Scholar
  10. 10.
    Harris W (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: ­treatment by mold arthroplasty. An end-result study using a new method of result. J Bone Joint Surg Am 51(4):737–755PubMedGoogle Scholar
  11. 11.
    Harris WH, McCarthy JC, O’Neill DA (1982) Femoral component loosening using ­contemporary techniques of femoral cement fixation. J Bone Joint Surg Am 64:1063–1067PubMedGoogle Scholar
  12. 12.
    Hart AJ, Buddhdev P et al (2008) Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int 18(3):212–219PubMedGoogle Scholar
  13. 13.
    Illgen RL 2nd, Heiner JP et al (2010) Large-head metal-on-metal total hip arthroplasty using the Durom acetabular component at minimum 1-year interval. J Arthroplasty 25(6 Suppl):26–30PubMedCrossRefGoogle Scholar
  14. 14.
    Lavigne M, Belzile EL et al (2011) Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve. J Bone Joint Surg Am 93(Suppl 2):128–136PubMedCrossRefGoogle Scholar
  15. 15.
    Long WT, Dastane M et al (2010) Failure of the Durom Metasul acetabular component. Clin Orthop Relat Res 468(2):400–405PubMedCrossRefGoogle Scholar
  16. 16.
    Massin P, Schmidt L et al (1989) Evaluation of cementless acetabular component migration. An experimental study. J Arthroplasty 4(3):245–251PubMedCrossRefGoogle Scholar
  17. 17.
    Mertl P, Boughebri O et al (2010) Large diameter head metal-on-metal bearings total hip arthroplasty: preliminary results. Orthop Traumatol Surg Res 96(1):14–20PubMedCrossRefGoogle Scholar
  18. 18.
    Morlock MM, Bishop N et al (2008) Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens. J Bone Joint Surg Am 90(Suppl 3):89–95PubMedCrossRefGoogle Scholar
  19. 19.
    Naal FD, Pilz R, Munzinger U, Hersche O, Leunig M (2011) High revision rate at 5 years after hip resurfacing with the Durom implant. Clin Orthop Relat Res 469(9):2598–2604PubMedCrossRefGoogle Scholar
  20. 20.
    Ng VY, Arnott L et al (2011) Perspectives in managing an implant recall: revision of 94 Durom Metasul acetabular components. J Bone Joint Surg Am 93(17):e100 (101–105)PubMedCrossRefGoogle Scholar
  21. 21.
    Schmalzried TP, Peters PC et al (1996) Long-duration metal-on-metal total hip arthroplasties with low wear of the articulating surfaces. J Arthroplasty 11(3):322–331PubMedCrossRefGoogle Scholar
  22. 22.
    Steffen RT, Foguet PR et al (2009) Femoral neck fractures after hip resurfacing. J Arthroplasty 24(4):614–619PubMedCrossRefGoogle Scholar
  23. 23.
    Sutherland CJ, Wilde AH et al (1982) A ten-year follow-up of one hundred consecutive Muller curved-stem total hip-replacement arthroplasties. J Bone Joint Surg Am 64(7):970–982PubMedGoogle Scholar
  24. 24.
    Theodorou EG, Provatidis CG et al (2011) Large diameter femoral heads impose significant alterations on the strains developed on femoral component and bone: a finite element analysis. Open Orthop J 5:229–238PubMedCrossRefGoogle Scholar
  25. 25.
    Uckay I, Lubbeke A et al (2009) Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 59(5):337–345PubMedCrossRefGoogle Scholar
  26. 26.
    Zahiri CA, Schmalzried TP et al (1998) Assessing activity in joint replacement patients. J Arthroplasty 13(8):890–895PubMedCrossRefGoogle Scholar

Copyright information

© EFORT 2012

Authors and Affiliations

  • Panayiotis Christofilopoulos
    • 1
  • Anne Lübbeke
    • 1
  • Charles Berton
    • 1
  • Alexandre Lädermann
    • 1
  • Martin Berli
    • 1
  • Constantinos Roussos
    • 1
  • Alexis Bonvin
    • 1
  • Robin Peter
    • 1
  • Pierre Hoffmeyer
    • 1
  1. 1.Département de ChirurgieChirurgie Orthopédique et Traumatologie de l’appareil Moteur, Hôpitaux Universitaires de GenèveGenève 14Switzerland

Personalised recommendations