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
Chapter

Abstract

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.

Keywords

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.

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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

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