Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 12/2012

01-12-2012 | Clinical Research

A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions

Authors: Roberto Civinini, MD, Christian Carulli, MD, Fabrizio Matassi, MD, Lorenzo Nistri, MD, Massimo Innocenti, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 12/2012

Login to get access

Abstract

Background

Isolated acetabular revisions using standard cups are at risk of dislocation. The introduction of a nonconstrained dual-mobility cup was designed to improve prosthetic stability without increasing loosening rates, but it is unclear whether the risk of dislocation is reduced.

Questions/purposes

We therefore determined: (1) if the rate of dislocation in isolated acetabular revisions is lower with a dual-mobility cup, (2) implant survival, (3) patient function, and (4) radiographic incidence of migration, loosening, and osteolysis.

Methods

We prospectively followed 33 selected patients who underwent isolated acetabular revisions with a minimum of 2 years’ followup (mean, 3 years; range, 2–5 years). In 24 patients a stainless steel dual-mobility cup was cemented into an antiprotrusio cage, whereas in nine we used a hyaluronan dual-mobility revision cup with a foramen hook and superior and posterior flanges screw fixations. We determined Harris hip (HHS) and WOMAC scores and examined radiographs for migration, loosening, and osteolysis.

Results

There were no dislocations. Survivorship rates of the femoral and acetabular components were 97% at 5 years; the rerevision rate for any reason was 3%. At last followup, the mean HHS increased from 48 points preoperatively to 86 points. No patients had progressive osteolysis, component migration, or loosening on radiographs.

Conclusion

In this select group of isolated acetabular revisions, our data suggest the use of a dual-mobility cup reduced the risk of dislocation without increasing loosening from 2 to 5 years.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Amstutz HC, Le Duff MJ, Beaule PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res. 2004;429:108–116.PubMedCrossRef Amstutz HC, Le Duff MJ, Beaule PE. Prevention and treatment of dislocation after total hip replacement using large diameter balls. Clin Orthop Relat Res. 2004;429:108–116.PubMedCrossRef
2.
go back to reference Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.PubMed Barrack RL, Mulroy RD Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasty: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389.PubMed
3.
go back to reference Beaule PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am. 2002;84:256–263.PubMed Beaule PE, Schmalzried TP, Udomkiat P, Amstutz HC. Jumbo femoral head for the treatment of recurrent dislocation following total hip replacement. J Bone Joint Surg Am. 2002;84:256–263.PubMed
4.
go back to reference Blom AW, Astle L, Loveridge J, Learmonth ID. Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br. 2005;87:1636–1638.PubMedCrossRef Blom AW, Astle L, Loveridge J, Learmonth ID. Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br. 2005;87:1636–1638.PubMedCrossRef
5.
go back to reference Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.PubMed Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–1632.PubMed
6.
go back to reference Chen XD, Waddell JP, Morton J, Schemitsch EH. Isolated acetabular revision after total hip arthroplasties: results at 5-9 years of follow up. Int Orthop. 2005;29:277–280.PubMedCrossRef Chen XD, Waddell JP, Morton J, Schemitsch EH. Isolated acetabular revision after total hip arthroplasties: results at 5-9 years of follow up. Int Orthop. 2005;29:277–280.PubMedCrossRef
7.
go back to reference Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplasty. 2005;20(7 suppl 3):103–107.PubMedCrossRef Della Valle CJ, Chang D, Sporer S, Berger RA, Rosenberg AG, Paprosky WG. High failure rate of a constrained acetabular liner in revision total hip arthroplasty. J Arthroplasty. 2005;20(7 suppl 3):103–107.PubMedCrossRef
8.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.PubMedCrossRef
9.
go back to reference Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T. Should the well-fixed, uncemented femoral components be revised during isolated acetabular revision? Arch Orthop Trauma Surg. 2011;131:481–485.PubMedCrossRef Fukui K, Kaneuji A, Sugimori T, Ichiseki T, Kitamura K, Matsumoto T. Should the well-fixed, uncemented femoral components be revised during isolated acetabular revision? Arch Orthop Trauma Surg. 2011;131:481–485.PubMedCrossRef
10.
go back to reference Glassman AH. Exposure for revision: total hip replacement. Clin Orthop Relat Res. 2004;420:39–47.PubMedCrossRef Glassman AH. Exposure for revision: total hip replacement. Clin Orthop Relat Res. 2004;420:39–47.PubMedCrossRef
11.
go back to reference Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed Gruen TA, McNeice GM, Amstutz HC. Modes of failure of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res. 1979;141:17–27.PubMed
12.
go back to reference Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19.PubMed Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19.PubMed
13.
go back to reference Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.PubMed
14.
go back to reference Jamali AA, Dungy DS, Mark A, Schule S, Harris WH. Isolated acetabular revision with use of the Harris-Galante cementless component. J Bone Joint Surg Am. 2004;86:1690–1697.PubMed Jamali AA, Dungy DS, Mark A, Schule S, Harris WH. Isolated acetabular revision with use of the Harris-Galante cementless component. J Bone Joint Surg Am. 2004;86:1690–1697.PubMed
15.
go back to reference Jones CP, Lachiewicz PF. Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions. J Bone Joint Surg Am. 2004;86:342–347.PubMedCrossRef Jones CP, Lachiewicz PF. Factors influencing the longer-term survival of uncemented acetabular components used in total hip revisions. J Bone Joint Surg Am. 2004;86:342–347.PubMedCrossRef
16.
go back to reference Khan RJ, Fick D, Alakeson R, Haebich S, de Cruz M, Nivbrant B, Wood D. A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br. 2006;88:870–876.PubMedCrossRef Khan RJ, Fick D, Alakeson R, Haebich S, de Cruz M, Nivbrant B, Wood D. A constrained acetabular component for recurrent dislocation. J Bone Joint Surg Br. 2006;88:870–876.PubMedCrossRef
17.
go back to reference Khan RJ, Fick D, Alakeson R, Li MG, Nivbrant B, Wood D. The constrained acetabular component for hip instability. J Arthroplasty. 2007;22:377–382.PubMedCrossRef Khan RJ, Fick D, Alakeson R, Li MG, Nivbrant B, Wood D. The constrained acetabular component for hip instability. J Arthroplasty. 2007;22:377–382.PubMedCrossRef
18.
go back to reference Khoury JI, Malkani AL, Adler EM, Markel DC. Constrained acetabular liners cemented into cages during total hip revision arthroplasty. J Arthroplasty. 2010;25:901–905.PubMedCrossRef Khoury JI, Malkani AL, Adler EM, Markel DC. Constrained acetabular liners cemented into cages during total hip revision arthroplasty. J Arthroplasty. 2010;25:901–905.PubMedCrossRef
19.
go back to reference Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32:46–51.PubMedCrossRef Klassbo M, Larsson E, Mannevik E. Hip disability and osteoarthritis outcome score. An extension of the Western Ontario and McMaster Universities Osteoarthritis Index. Scand J Rheumatol. 2003;32:46–51.PubMedCrossRef
20.
go back to reference Lachiewicz PF, Kelley SS. The use of constrained components in total hip arthroplasty. J Am Acad Orthop Surg. 2002;10:233–238.PubMed Lachiewicz PF, Kelley SS. The use of constrained components in total hip arthroplasty. J Am Acad Orthop Surg. 2002;10:233–238.PubMed
21.
go back to reference 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;466:389–395.PubMedCrossRef 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;466:389–395.PubMedCrossRef
22.
go back to reference Lawless BM, Healy WL, Sharma S, Iorio R. Outcomes of isolated acetabular revision. Clin Orthop Relat Res. 2010;468:472–479.PubMedCrossRef Lawless BM, Healy WL, Sharma S, Iorio R. Outcomes of isolated acetabular revision. Clin Orthop Relat Res. 2010;468:472–479.PubMedCrossRef
23.
go back to reference Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Merl P. Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 8 years’ follow-up. Orthop Traumatol Surg Res. 2011;97:8–13.PubMedCrossRef Leiber-Wackenheim F, Brunschweiler B, Ehlinger M, Gabrion A, Merl P. Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: a 59 cases series with a mean 8 years’ follow-up. Orthop Traumatol Surg Res. 2011;97:8–13.PubMedCrossRef
24.
go back to reference Levine BR, Della Valle CJ, Deirmengian CA, Breien KM, Weeden SH, Sporer SM, Paprosky WG. The use of a tripolar articulation in revision total hip arthroplasty. J Arthroplasty. 2008;23:1182–1188.PubMedCrossRef Levine BR, Della Valle CJ, Deirmengian CA, Breien KM, Weeden SH, Sporer SM, Paprosky WG. The use of a tripolar articulation in revision total hip arthroplasty. J Arthroplasty. 2008;23:1182–1188.PubMedCrossRef
25.
go back to reference Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.PubMed Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. 1990;72:518–528.PubMed
26.
go back to reference Manning DW, Ponce BA, Chiang PP, Harris WH, Burke DW. Isolated acetabular revision through the posterior approach: short-term results after revision of a recalled acetabular component. J Arthroplasty. 2005;20:723–729.PubMedCrossRef Manning DW, Ponce BA, Chiang PP, Harris WH, Burke DW. Isolated acetabular revision through the posterior approach: short-term results after revision of a recalled acetabular component. J Arthroplasty. 2005;20:723–729.PubMedCrossRef
27.
go back to reference Massin P, Besnier L. Acetabular revision of total hip arthroplasty using a press-fit dual mobility cup. Orthop Traumatol Surg Res. 2010;96:9–13.PubMedCrossRef Massin P, Besnier L. Acetabular revision of total hip arthroplasty using a press-fit dual mobility cup. Orthop Traumatol Surg Res. 2010;96:9–13.PubMedCrossRef
28.
go back to reference Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.PubMedCrossRef Massin P, Schmidt L, Engh CA. Evaluation of cementless acetabular component migration: an experimental study. J Arthroplasty. 1989;4:245–251.PubMedCrossRef
29.
go back to reference McCarthy JC, Lee JA. Constrained acetabular components in complex revision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:210–215.PubMedCrossRef McCarthy JC, Lee JA. Constrained acetabular components in complex revision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:210–215.PubMedCrossRef
30.
go back to reference Moskal JT, Shen FH, Brown TE. The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study. J Bone Joint Surg Am. 2002;84:250–255.PubMed Moskal JT, Shen FH, Brown TE. The fate of stable femoral components retained during isolated acetabular revision: a six-to-twelve-year follow-up study. J Bone Joint Surg Am. 2002;84:250–255.PubMed
31.
go back to reference Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2011 Dec 17. [Epub ahead of print]. Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2011 Dec 17. [Epub ahead of print].
32.
go back to reference Owens WB, Felts JA, Spritznagel EL. ASA physical status classification: a study of consistency of ratings. Anaesthesiology. 1978;49:239–243.CrossRef Owens WB, Felts JA, Spritznagel EL. ASA physical status classification: a study of consistency of ratings. Anaesthesiology. 1978;49:239–243.CrossRef
33.
go back to reference Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty: acetabular technique. Clin Orthop Relat Res. 1994;298:147–155.PubMed Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty: acetabular technique. Clin Orthop Relat Res. 1994;298:147–155.PubMed
34.
go back to reference Philippot R, Camilleri JF, Boyer B, Adam P, Farizon F. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop. 2009;33:927–932.PubMedCrossRef Philippot R, Camilleri JF, Boyer B, Adam P, Farizon F. The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years. Int Orthop. 2009;33:927–932.PubMedCrossRef
35.
go back to reference Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F. [Survival of dual mobility socket with a mean 17 years follow-up] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:43–48.PubMedCrossRef Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, Fessy MH, Lecuire F. [Survival of dual mobility socket with a mean 17 years follow-up] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:43–48.PubMedCrossRef
36.
go back to reference Poon ED, Lachiewicz PF. Results of isolated acetabular revisions: the fate of the unrevised femoral component. J Arthroplasty. 1998;13:42–49.PubMedCrossRef Poon ED, Lachiewicz PF. Results of isolated acetabular revisions: the fate of the unrevised femoral component. J Arthroplasty. 1998;13:42–49.PubMedCrossRef
37.
go back to reference Schneider L, Philippot R, Boyea B, Farizon F. Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res. 2011;97:807–813.PubMedCrossRef Schneider L, Philippot R, Boyea B, Farizon F. Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res. 2011;97:807–813.PubMedCrossRef
38.
go back to reference Tanzer M, Drucker D, Jasty M. Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg Am. 1992;74:987–994.PubMed Tanzer M, Drucker D, Jasty M. Revision of the acetabular component with an uncemented Harris-Galante porous-coated prosthesis. J Bone Joint Surg Am. 1992;74:987–994.PubMed
39.
go back to reference Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–222.PubMedCrossRef Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–222.PubMedCrossRef
Metadata
Title
A Dual-mobility Cup Reduces Risk of Dislocation in Isolated Acetabular Revisions
Authors
Roberto Civinini, MD
Christian Carulli, MD
Fabrizio Matassi, MD
Lorenzo Nistri, MD
Massimo Innocenti, MD
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 12/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2428-y

Other articles of this Issue 12/2012

Clinical Orthopaedics and Related Research® 12/2012 Go to the issue

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery

Hip Capsule Dimensions in Patients With Femoroacetabular Impingement: A Pilot Study