Preliminary Results of Total Hip Arthroplasty in Subjects at Risk for Dislocation Using a Novel Modular Cementless Dual-Mobility Cup. A Single-Center Prospective Study

Giuseppe Solarino,Flavia Riefoli,Biagio Moretti,Antonello Panella,Filippo Simone,Arianna Carlet

doi:10.3390/prosthesis3010006

Giuseppe Solarino, Flavia Riefoli + Show 4 more

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https://doi.org/10.3390/prosthesis3010006

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Abstract

Nowadays total hip arthroplasty (THA) is widely considered the operation of the century in orthopedic and traumatological fields. Despite this fact, instability and dislocation after THA are a common reason for revision surgery. The purpose of this prospective study is to evaluate the preliminary clinical and radiological results of a novel dual mobility cup. We evaluated 32 consecutive cases of patients who underwent THA using a novel dual mobility cup—with holes in the cup, a modular metallic inlay and a crosslinked polyethylene. All of them were considered at risk of instability of the implant due to primary or concomitant diagnosis. The preoperative Harris hip score was 54.7 on average. At a minimum 2 years follow-up, the mean HHS raised up to a mean value of 88.4; this improvement was statistically significant (p < 0.0001). None of the patients enrolled in this study sustained a postoperative dislocation at a mean follow-up of 39.6 months. Furthermore, no patients sustained modular liner dissociation or an intraprosthetic dislocation. As such, survivorship free from dislocation was 100% at both 2 and 5 years. This study demonstrates that the modular dual mobility (DM) socket provides dual articulation, larger jump distance, and greater range of motion before impingement, which significantly reduce the rate of dislocation.

Highlights

In the 1960s, hip replacement revolutionized management of patients affected by hip osteoarthritis, and nowadays total hip arthroplasty (THA) is widely considered one of the most successful procedures producing excellent outcomes, being named the operation of the century in orthopaedical and traumatological fields
Instability and dislocation after THA are a common reason for revision surgery and they are perceived as a serious complication by both surgeons and patients [1]
We prospectively evaluated the records of 32 consecutive cases of patients who underwent primary THR using a novel dual mobility (DM) acetabular system; exclusion criteria included patients with less than two-year minimum follow-up and patients with active or previous hip joint infection

Summary

Introduction

In the 1960s, hip replacement revolutionized management of patients affected by hip osteoarthritis, and nowadays total hip arthroplasty (THA) is widely considered one of the most successful procedures producing excellent outcomes, being named the operation of the century in orthopaedical and traumatological fields. Instability and dislocation after THA are a common reason for revision surgery and they are perceived as a serious complication by both surgeons and patients [1]. Instability following THA is a multi-factorial event, with different etiologies, and eventually several categories of risk factors are recognized, related to the patients and/or to the surgeons’ choice: primary diagnosis such as femoral neck fracture and post-traumatic arthritis, secondary diagnosis at the neighbor joints such as spino-pelvic imbalance, neurological and psychiatric disorders such as Parkinson’s disease, epilepsy, and schizophrenia, implant orientation and design, and laxity of the surrounding soft tissues [2,3,4]. The concept of dual mobility (DM) was thought up in the 1970s and combined two articulations: one large and one smaller by a recruitment phenomenon increasing the jumps distance and so decreasing dislocation forces, with advantages of large head without adverse effects. Wear of the PE could lead to macrophagic reaction and consequent periprosthetic osteolysis and mechanical failure [5,6]

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