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Mid-Term Outcomes of Modular Dual Mobility Bearings in Total Hip Arthroplasty
Modular dual mobility (MDM) prostheses in which a cobalt–chromium liner is inserted into a titanium acetabular shell have the potential for corrosion. This has raised concern. While these constructs have been shown to effectively reduce the risk of dislocation in revision and high-risk primary total hip arthroplasty (THA), previous studies have been limited by the length of follow-up. The purpose of the study is to review the mid-term clinical outcomes of MDM implants with a minimum of 5-year follow-up. A retrospective, observational study was conducted on all consecutive patients who underwent THA with a MDM implant from June 2011 and March 2017 at an urban, tertiary academic medical center. Descriptive statistics were used to describe baseline patient characteristics. Primary endpoints included revision rates, dislocations rates, and implant component survivorship. Implant survival was analyzed using the Kaplan–Meier method. A total of 92 cases (61 primary, 31 revision) underwent THA with a MDM implant at an average follow-up of 6.90 ± 1.48 years (range: 5.01–10.53 years). The mean patient age at the time of surgery was 58.20 ± 11.85 years. Six patients were revised (6.5%, 6/92), two for periprosthetic joint infection (2.2%, 2/92), one due to aseptic loosening (1.1%, 1/92), one due to periprosthetic fracture (1.1%, 1/92), and the remaining two for metallosis (2.2%, 2/92). Kaplan–Meier survivorship analysis showed a 93.5% survival rate for all-cause revisions and 98.9% survival for acetabular component revision. MDM components reliably decrease the risk of dislocation after THA. However, the occurrence of two revisions due to metallosis demonstrates the necessity for continued surveillance in this cohort. Larger trials with long-term follow-up may be required to further elucidate the long-term outcomes and performance of these bearings.
W.M. reports being a board or committee member for AAHKS, being part of the editorial or governing board for Clinical Orthopaedics and Related Research and JOA, having stock and stock options in OrthAlign, and being an unpaid consultant for ORamaVR, outside of the submitted work. R.S. reports being a board or committee member for AAOS and AAHKS, being part of the editorial or governing board for Arthroplasty Today and JOA, having stock and stock options in Gauss surgical and PSI, being a paid consultant and having stock or stock options in Intelijoint, and being a paid consultant and receiving IP royalties and research support from Smith and Nephew, outside of the submitted work. Other authors have nothing to disclose.
Received: 27 August 2022
Accepted: 16 June 2023
Article published online:
21 August 2023
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- 1 Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007; 370 (9597) 1508-1519
- 2 NIH Consensus Development Panel on Total Hip Replacement. NIH consensus conference: total hip replacement. JAMA 1995; 273 (24) 1950-1956
- 3 Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 2007; 22 (4, Suppl 1): 86-90
- 4 Parvizi J, Kim KI, Goldberg G, Mallo G, Hozack WJ. Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res 2006; 447 (447) 60-65
- 5 Jones CW, De Martino I, D'Apolito R, Nocon AA, Sculco PK, Sculco TP. The use of dual-mobility bearings in patients at high risk of dislocation. Bone Joint J 2019; 101-B (1_Supple_A): 41-45
- 6 Vajapey SP, Fideler KL, Lynch D, Li M. Use of dual mobility components in total hip arthroplasty: indications and outcomes. J Clin Orthop Trauma 2020; 11 (Suppl. 05) S760-S765
- 7 Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles. Instr Course Lect 2009; 58: 183-191
- 8 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
- 9 Nonne D, Sanna F, Bardelli A, Milano P, Rivera F. Use of a dual mobility cup to prevent hip early arthroplasty dislocation in patients at high falls risk. Injury 2019; 50 (Suppl. 04) S26-S29
- 10 Abdelaal MS, Zachwieja E, Sharkey PF. Severe corrosion of modular dual mobility acetabular components identified during revision total hip arthroplasty. Arthroplast Today 2021; 8: 78-83
- 11 Lombardo DJ, Siljander MP, Gehrke CK, Moore DD, Karadsheh MS, Baker EA. Fretting and corrosion damage of retrieved dual-mobility total hip arthroplasty systems. J Arthroplasty 2019; 34 (06) 1273-1278
- 12 Civinini R, Cozzi Lepri A, Carulli C, Matassi F, Villano M, Innocenti M. Patients following revision total hip arthroplasty with modular dual mobility components and cobalt-chromium inner metal head are at risk of increased serum metal ion levels. J Arthroplasty 2020; 35 (6S): S294-S298
- 13 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
- 14 Blythe ROPM, Crawford RW. et al. Australia g Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Orthopaedic Research Unit, Level 2020; 5 DOI: 10.5694/j.1326-5377.2004.tb05911.x.
- 15 Buckland AJ, Ayres EW, Shimmin AJ, Bare JV, McMahon SJ, Vigdorchik JM. Prevalence of sagittal spinal deformity among patients undergoing total hip arthroplasty. J Arthroplasty 2020; 35 (01) 160-165
- 16 Dhawan R, Baré JV, Shimmin A. Modular dual-mobility articulations in patients with adverse spinopelvic mobility. Bone Joint J 2022; 104-B (07) 820-825
- 17 Park CW, Lim SJ, Kim IS, Jang MC, Moon YW, Park YS. Outcomes of revision total hip arthroplasty using the modular dual mobility acetabular system to treat recurrent dislocation. Int Orthop 2022; 46 (04) 789-795
- 18 Darrith B, Courtney PM, Della Valle CJ. Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J 2018; 100-B (01) 11-19
- 19 Dubin JA, Westrich GH. Anatomic dual mobility compared to modular dual mobility in primary total hip arthroplasty: a matched cohort study. Arthroplast Today 2019; 5 (04) 509-514
- 20 Pakarinen O, Lainiala O, Reito A, Neuvonen P, Mäkelä K, Eskelinen A. Implant survival of 662 dual-mobility cups and 727 constrained liners in primary THA: small femoral head size increases the cumulative incidence of revision. Acta Orthop 2021; 92 (06) 658-664
- 21 Lawrie CM, Barrack RL, Nunley RM. Modular dual mobility total hip arthroplasty is a viable option for young, active patients: a mid-term follow-up study. Bone Joint J 2021; 103-B (7, Supple B): 73-77
- 22 Baker CM, Restrepo C, Hozack WJ. Minimum five-year outcomes of modular dual mobility in primary total hip arthroplasty. J Arthroplasty 2022; 37 (7S): S566-S570
- 23 Chan PK, Cheung SL, Lam KH. et al. Use of a modular hip dual-mobility articulation in patients with high risk of dislocation: a relatively small-sized acetabulum in Asian patients may limit its use. Arthroplasty 2021; 3 (01) 7 DOI: 10.1186/s42836-020-00066-0.
- 24 De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J Orthop 2014; 5 (03) 180-187
- 25 Nam D, Salih R, Brown KM, Nunley RM, Barrack RL. Metal ion levels in young, active patients receiving a modular, dual mobility total hip arthroplasty. J Arthroplasty 2017; 32 (05) 1581-1585
- 26 Romero J, Wach A, Silberberg S. et al. Otto Aufranc Award: malseating of modular dual mobility liners: incidence and implications. Bone Joint J 2020; DOI: 10.1302/0301-620X.102B7.BJJ-2019-1633.R1.
- 27 Gkiatas I, Sharma AK, Greenberg A, Duncan ST, Chalmers BP, Sculco PK. Serum metal ion levels in modular dual mobility acetabular components: a systematic review. J Orthop 2020; 21: 432-437
- 28 French JMR, Bramley P, Scattergood S, Sandiford NA. Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis. EFORT Open Rev 2021; 6 (05) 343-353