Download PDF
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

Nishanth Muthusamy 
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
› Further Information
    Permissions and Reprints

Abstract

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.

Keywords

revision total hip arthroplasty - dual mobility - cemented dual mobility - dislocation - instability


Publication History

Received: 23 November 2021

Accepted: 13 June 2022

Article published online:
07 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 9 Guyen O. Constrained liners, dual mobility or large diameter heads to avoid dislocation in THA. EFORT Open Rev 2017; 1 (05) 197-204
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 17 Prudhon JL. Dual-mobility cup and cemented femoral component: 6 year follow-up results. Hip Int 2011; 21 (06) 713-717
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar