The Journal of Hip Surgery 2022; 06(03): 117-123
DOI: 10.1055/s-0042-1756277
Original Article

Midterm Outcomes of a Monoblock Dual-Mobility Cup Cemented into a Fully Porous Acetabular Component in Revision Total Hip Arthroplasty

1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
Ittai Shichman
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
2   Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Chelsea S. Sicat
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
Scott Marwin
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
Morteza Meftah
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
Ran Schwarzkopf
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
› Author Affiliations


Utilization of dual-mobility (DM) constructs has been a promising management option to address the risk of hip instability after complex revision total hip arthroplasty (rTHA). The aim of this study is to report a minimum 2-year outcome and survivorship of a monoblock DM cup cemented in a fully porous acetabular shell in complex acetabular rTHA cases. A retrospective review of 76 patients who underwent rTHA with a novel construct that utilized an inner DM cup cemented into a fully porous outer acetabular metal shell was conducted. Demographics, radiographic, and clinical outcomes such as readmissions, dislocation, and revisions were collected. Survivorship was analyzed by the Kaplan–Meier (KM) method. Thirty cases with a minimum of 2-year follow-up were included. Patients were, on average, 65.17 ± 10.26 years old with a mean body mass index of 28.55 ± 6.33 kg/m2. Seven patients (23.3%) required reoperations. Four patients underwent acetabular revision (periprosthetic joint infection: n = 2 [6.7%]; dislocation: n = 1 [3.3%]; aseptic loosening [fully porous cup]: n = 1[3.3%]). Three patients underwent reoperation without acetabular implant revision (debridement, antibiotics, and implant retention for prosthetic joint infection: n = 2 [6.7%]; femoral periprosthetic fracture: n = 1 [3.3%]). KM survivorship analysis of all-cause acetabular revision showed survival rates of 96.7% at 6 months, 93.3% at 1 year, and 89.7% at 2 years. KM survivorship of aseptic acetabular revision showed rates of 96.7% at 1 year and 92.9% at 2 years. KM analysis of acetabular cup fixation showed rates of 100% at 1 year and 96.2% at 2 years. The rate of dislocation in our cohort was 3.3% (1 out of 30). The use of a DM acetabular cup cemented into a fully porous acetabular revision shell in complex rTHA cases has a low risk of instability and loosening at 2 years with excellent mid-term implant survivorship. The use of this construct is a good option in patients with complex acetabular reconstruction and an elevated risk for instability. This was a retrospective cohort study with a level III evidence.

Publication History

Received: 23 November 2021

Accepted: 13 June 2022

Article published online:
07 September 2022

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  • References

  • 1 Yu S, Saleh H, Bolz N. et al. Re-revision total hip arthroplasty: epidemiology and factors associated with outcomes. J Clin Orthop Trauma 2020; 11 (01) 43-46
  • 2 Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res 2010; 468 (11) 3070-3076
  • 3 Khatod M, Cafri G, Inacio MCS, Schepps AL, Paxton EW, Bini SA. Revision total hip arthoplasty: factors associated with re-revision surgery. J Bone Joint Surg Am 2015; 97 (05) 359-366
  • 4 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; 91 (01) 128-133
  • 5 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 (07) 2088-2092
  • 6 Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res 2009; 467 (01) 166-173
  • 7 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 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 8 Schwartz AM, Farley KX, Guild GN, Bradbury Jr TL. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty 2020; 35 (6S): S79-S85
  • 9 Guyen O. Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA. EFORT Open Rev 2017; 1 (05) 197-204
  • 10 Khan RJK, Fick D, Alakeson R. et al. A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br 2006; 88 (07) 870-876
  • 11 Bremner BRB, Goetz DD, Callaghan JJ, Capello WN, Johnston RC. Use of constrained acetabular components for hip instability: an average 10-year follow-up study. J Arthroplasty 2003; 18 (07, Suppl 01): 131-137
  • 12 Garbuz DS, Masri BA, Duncan CP. et al. The Frank Stinchfield Award: dislocation in revision THA: do large heads (36 and 40 mm) result in reduced dislocation rates in a randomized clinical trial?. Clin Orthop Relat Res 2012; 470 (02) 351-356
  • 13 Halley D, Glassman A, Crowninshield RD. Recurrent dislocation after revision total hip replacement with a large prosthetic femoral head. A case report. J Bone Joint Surg Am 2004; 86 (04) 827-830
  • 14 Lachiewicz PF, Soileau ES, Martell JM. Wear and osteolysis of highly crosslinked polyethylene at 10 to 14 years: the effect of femoral head size. Clin Orthop Relat Res 2016; 474 (02) 365-371
  • 15 Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am 2007; 89 (10) 2212-2217
  • 16 Jauregui JJ, Pierce TP, Elmallah RK, Cherian JJ, Delanois RE, Mont MA. Dual mobility cups: an effective prosthesis in revision total hip arthroplasties for preventing dislocations. Hip Int 2016; 26 (01) 57-61
  • 17 Prudhon JL. Dual-mobility cup and cemented femoral component: 6 year follow-up results. Hip Int 2011; 21 (06) 713-717
  • 18 Wakeling CP, Sandiford NA, Ghani R, Bridle SJ, Mitchell PA, Hutt JR. Dual-mobility bearings in complex revision hip arthroplasty. Hip Int 2022; 32 (04) 460-465
  • 19 Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res 2008; 466 (02) 389-395
  • 20 Civinini R, Carulli C, Matassi F, Nistri L, Innocenti M. A dual-mobility cup reduces risk of dislocation in isolated acetabular revisions. Clin Orthop Relat Res 2012; 470 (12) 3542-3548
  • 21 Simian E, Chatellard R, Druon J, Berhouet J, Rosset P. Dual mobility cup in revision total hip arthroplasty: dislocation rate and survival after 5 years. Orthop Traumatol Surg Res 2015; 101 (05) 577-581
  • 22 Hamadouche M, Biau DJ, Huten D, Musset T, Gaucher F. The use of a cemented dual mobility socket to treat recurrent dislocation. Clin Orthop Relat Res 2010; 468 (12) 3248-3254
  • 23 Mertl P, Combes A, Leiber-Wackenheim F, Fessy MH, Girard J, Migaud H. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSS J 2012; 8 (03) 251-256
  • 24 Guyen O, Pibarot V, Vaz G, Chevillotte C, Béjui-Hugues J. Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res 2009; 467 (02) 465-472
  • 25 Plummer DR, Christy JM, Sporer SM, Paprosky WG, Della Valle CJ. Dual-mobility articulations for patients at high risk for dislocation. J Arthroplasty 2016; 31 (9, Suppl): 131-135
  • 26 Chalmers BP, Ledford CK, Taunton MJ, Sierra RJ, Lewallen DG, Trousdale RT. Cementation of a dual mobility construct in recurrently dislocating and high risk patients undergoing revision total arthroplasty. J Arthroplasty 2018; 33 (05) 1501-1506
  • 27 Evangelista P, Okroj K, Plummer D. et al. Do cemented dual-mobility cups confer stability for patients at high risk of dislocation in revision total hip arthroplasty?. J Hip Surg 2018; 2: 88-91
  • 28 Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty 1994; 9 (01) 33-44
  • 29 Gabor JA, Feng JE, Gupta S. et al. Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty. Arthroplast Today 2019; 5 (03) 341-347
  • 30 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 (ASuppl1): 18-24
  • 31 Wegrzyn J, Thoreson AR, Guyen O, Lewallen DG, An KN. Cementation of a dual-mobility acetabular component into a well-fixed metal shell during revision total hip arthroplasty: a biomechanical validation. J Orthop Res 2013; 31 (06) 991-997
  • 32 Beaulé PE, Ebramzadeh E, Le Duff M, Prasad R, Amstutz HC. Cementing a liner into a stable cementless acetabular shell: the double-socket technique. J Bone Joint Surg Am 2004; 86 (05) 929-934
  • 33 Beckmann NA, Jaeger S, Janoszka MB, Klotz MC, Bruckner T, Bitsch RG. Comparison of the primary stability of a porous coated acetabular revision cup with a standard cup. J Arthroplasty 2018; 33 (02) 580-585
  • 34 Hamadouche M, Ropars M, Rodaix C. et al. Five to thirteen year results of a cemented dual mobility socket to treat recurrent dislocation. Int Orthop 2017; 41 (03) 513-519
  • 35 Colacchio ND, Wooten CJ, Martin JR, Masonis JL, Fehring TK. Dual mobility for monoblock metal-on-metal revision-is it safe?. J Arthroplasty 2020; 35 (02) 508-512
  • 36 Rudy HL, Padilla JA, Gabor JA, Iorio R, Schwarzkopf R, Vigdorchik J. Cost-effectiveness of dual mobility and a value-based algorithm of utilization. Orthop Clin North Am 2019; 50 (02) 151-158
  • 37 Elbuluk AM, Slover J, Anoushiravani AA, Schwarzkopf R, Eftekhary N, Vigdorchik JM. The cost-effectiveness of dual mobility in a spinal deformity population with high risk of dislocation: a computer-based model. Bone Joint J 2018; 100-B (10) 1297-1302
  • 38 Giacomo P, Giulia B, Valerio P, Vincenzo S, Pierluigi A. Dual mobility for total hip arthroplasty revision surgery: a systematic review and metanalysis. SICOT J 2021; 7: 18 DOI: 10.1051/sicotj/2021015.
  • 39 Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual mobility cups in revision total hip arthroplasty: efficient strategy to decrease dislocation risk. J Arthroplasty 2020; 35 (02) 500-507