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Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study

  • Original Article
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HSS Journal ®

Abstract

Background

Groin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain.

Questions/Purposes

The goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR.

Methods

After combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position.

Results

Overall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain.

Conclusion

In this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.

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References

  1. Abbas AA, Kim YJ, Song EK, Yoon TR. Oversized acetabular socket causing groin pain after total hip arthroplasty. J Arthroplasty. 2009;24:1144–1147.

    Article  Google Scholar 

  2. Bartelt RB, Yuan BJ, Trousdale RT, Sierra RJ. The prevalence of groin pain after metal-on-metal total hip arthroplasty and total hip resurfacing. Clin Orthop Relat Res. 2010;468:2346–2356.

    Article  Google Scholar 

  3. Batailler C, Bonin N, Wettstein M, et al. Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: retrospective study of 46 patients. Orthop Traumatol Surg Res. 2017;103(8):1147–1153.

    Article  CAS  Google Scholar 

  4. Baumgarten KM, McKenzie MJ. Iliopsoas tendon impingement after total hip arthroplasty using a large diameter femoral head. JBJS Case Connect. 2012;2(2):221–225.

    Article  Google Scholar 

  5. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87(6):762–769.

    Article  CAS  Google Scholar 

  6. Bin Nasser A, Beaulé PE, O’Neill M, Kim PR, Fazekas A. Incidence of groin pain after metal-on-metal hip resurfacing. Clin Orthop Relat Res. 2010;468(2):392–399.

    Article  Google Scholar 

  7. Bozic KJ, Kamath AF, Ong K, et al. Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res. 2015;473(6):2131–2138.

    Article  Google Scholar 

  8. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;1(1):128–133.

  9. Browne JA, Polga DJ, Sierra RJ, Trousdale RT, Cabanela ME. Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement. J Arthroplasty. 2011;26:978–975.

    PubMed  Google Scholar 

  10. Cooper HJ, Della Valle CJ, Berger RA, et al. Corrosion at the head–neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94:1655–1661.

    Article  Google Scholar 

  11. Cooper HJ, Della Valle CJ, Jacobs JJ. Biologic implications of taper corrosion in total hip arthroplasty. Semin Arthroplasty. 2012;23:273–278.

  12. Cooper HR, Della Valle CJ. Large diameter femoral heads: is bigger always better? Bone Joint J. 2014;96-B(11 Supple A):23–26.

  13. De Martino I, D’Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components: a systematic review. Bone Joint J. 2017;99-B(A Suppl 1):18–24.

    Article  Google Scholar 

  14. Epinette JA, Harwin SF, Rowan FE, et al. Early experience with dual mobility acetabular systems featuring highly cross-linked polyethylene liners for primary hip arthroplasty in patients under fifty five years of age: an international multi-centre preliminary study. Int Orthop. 2017;41(3):543–550.

    Article  Google Scholar 

  15. Girard J. Femoral head diameter considerations for primary total hip arthroplasty. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S25–S29.

    Article  CAS  Google Scholar 

  16. Gwam CU, Mistry JB, Mohamed NS, et al. Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty. 2017;32(7):2088–2092.

    Article  Google Scholar 

  17. Howie DW, Holubowycz OT, Middleton R, Large Articulation Study Group. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94-A:1095–1102.

    Article  Google Scholar 

  18. Katz JN, Wright EA, Wright J, et al. Twelve-year risk of revision after primary total hip replacement in the U.S. Medicare population. J Bone Joint Surg Am. 2012;94(20):1825-1832.

    Article  Google Scholar 

  19. Ko LM, Hozack WJ. The dual mobility cup: what problems does it solve? Bone Joint J. 2016;98-B(1 Suppl A):60–63.

    Article  Google Scholar 

  20. Krismer M, Bauer R, Tschupik J, Mayrhofer P. EBRA: a method to measure migration of acetabular components. J Biomech. 1995;28(10):1225–1236.

    Article  CAS  Google Scholar 

  21. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005–2030. J Bone Joint Surg Am. 2007; 89:780–785.

    Article  Google Scholar 

  22. Lachiewicz PF, Soileau ES. Changing indications for revision total hip arthroplasty. J Surg Orthop Adv. 2005;14:82–84.

  23. Lavigne M, Laffosse JM, Ganapathi M, Girard J, Vendittoli P. Residual groin pain at a minimum of two years after metal-on-metal THA with a twenty-eight-millimeter femoral head, THA with a large-diameter femoral head, and hip resurfacing. J Bone Joint Surg Am. 2011;93 Suppl 2:93–98.

    Article  Google Scholar 

  24. Plummer DR, Haughom BD, Della Valle CJ. Dual mobility in total hip arthroplasty. Orthop Clin North Am. 2014;45:1–8.

    Article  Google Scholar 

  25. Rowan FE, Salvatore AJ, Lange JK, Westrich GH. Dual-mobility vs fixed-bearing total hip arthroplasty in patients under 55 years of age: a single-institution, matched-cohort analysis. J Arthroplasty. 2017;32(10):3076–3081.

    Article  Google Scholar 

  26. Sutter EG, McClellan TR, Attarian DE, Bolognesi MP, Lachiewicz PF, Wellman SS. Outcomes of modular dual mobility acetabular components in revision total hip arthroplasty. J Arthroplasty. 2017;32(9S):S220–S224.

    Article  Google Scholar 

  27. Toni A, Baleani M, Bordini B, et al. “Trunionitis”: a cause for concern? Semin Arthroplasty. 2012;23:248–250.

    Article  Google Scholar 

  28. Trousdale RT, Cabanela ME, Berry DJ. Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty. 1995;10:546.

    Article  CAS  Google Scholar 

  29. Ulrich SD, Seyler TM, Bennett D, et al. Total hip arthroplasties: what are the reasons for revision? Int Orthop. 2008;32:597–604.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Alexandra I. Stavrakis MD

  2. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Amir Khoshbin MD

  3. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, NY, USA

    Amethia Joseph MS, Lily Y. Lee MS, Mathias P. Bostrom MD, Geoffrey H. Westrich MD & Alexander S. McLawhorn MD

Authors
  1. Alexandra I. Stavrakis MD
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  2. Amir Khoshbin MD
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  3. Amethia Joseph MS
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  4. Lily Y. Lee MS
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  5. Mathias P. Bostrom MD
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  6. Geoffrey H. Westrich MD
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  7. Alexander S. McLawhorn MD
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Correspondence to Alexandra I. Stavrakis MD.

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Conflict of Interest

Alexandra I. Stavrakis, MD, Amir Khoshbin, MD, Amethia Joseph, MS, and Lily Y. Lee, MS, declare that they have no conflicts of interest. Mathias P. Bostrom, MD, reports royalties or licensing payments and consulting and other fees from Smith and Nephew, outside the submitted work. Geoffrey H. Westrich, MD, reports royalties or licensing payments and consulting fees from Stryker and consulting fees from Exactech, outside the submitted work. Alexander S. McLawhorn, MD, reports consulting and other fees from Ethicon and Intellijoint Surgical, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study. Each author certifies that his or her institution has approved the reporting of these cases.

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Additional information

Level of Evidence: Level III: Retrospective Cohort Study.

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Stavrakis, A.I., Khoshbin, A., Joseph, A. et al. Dual Mobility Total Hip Arthroplasty Is Not Associated with a Greater Incidence of Groin Pain in Comparison with Conventional Total Hip Arthroplasty and Hip Resurfacing:A Retrospective Comparative Study. HSS Jrnl 16 (Suppl 2), 394–399 (2020). https://doi.org/10.1007/s11420-020-09764-6

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  • DOI: https://doi.org/10.1007/s11420-020-09764-6

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