Cemented Dual Mobility Cup Research Articles

Do Cemented Dual-Mobility Cups Confer Stability for Patients at High Risk of Dislocation in Revision Total Hip Arthroplasty?

AbstractDislocation is among the most commonly reported complications following revision total hip arthroplasty. Dual-mobility bearings may lower the risk of dislocation. The authors report the results of a multicenter study evaluating the use of a dual-mobility acetabular cup design that was cemented into a metal shell as part of complex acetabular reconstructions or in cases where the risk of dislocation was felt to be high, such as isolated bearing exchanges. Eighteen patients were identified for being at high risk of dislocation who underwent cementation of a dual-mobility shell that is specifically made for cementation, into a fully porous metal revision acetabular cup (10 patients) or into a well-fixed cup at the time of revision without removal of the existing acetabular component (eight patients). Patients were assessed clinically and radiographically at a minimum of 2 years for the evidence of dislocation, revision surgery, and implant loosening. At a mean of 36 months (range, 25–56 months), one patient died and one was lost to follow-up. There were no known cases of hip dislocation. There was one repeat revision, for a deep infection treated with irrigation and debridement. The mean preoperative Harris Hip Score of 46 (range, 40–79) improved to a mean of 65 points (range, 41–97) at the most recent evaluation. Acetabular components were retained in 8 out of 18 cases and the dual-mobility shell was cemented into it. Cementation of a dual-mobility cup into a shell at the time of a revision surgery is a safe and reliable construct at minimum of 2 years for patients at high risk of dislocation. There were no complications related to the cementation of the cup into the metal shell. Longer follow-up is required to further assess the durability of this construct.

Functional outcome and health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in middle aged Egyptian patients

AimThis study was done to assess the functional and clinical results after one year of cemented THR with dual mobility cup for the treatment of fracture neck femur in active middle-aged patients in Egypt (Middle Eastern population). Patients and methodsThis study included 31 patients (32 hips) with displaced femoral neck fractures that were admitted to El Hadara University Hospital, Alexandria, Egypt. Their mean age was 66.4 ± 5.9 years. Fifteen patients were females. All the patients were treated with total hip replacement using a cemented dual mobility cup (Ecofit® 2 M, Implantcast GmbH, Germany) total hip replacement through the standard posterior approach. Functional assessment was done using Harris Hip Score (HHS), SF-36 questionnaire for health related quality of life (HRQoL) with assistance of a physiotherapist. ResultsThe mean HHS improved over the follow up period from 79.04 ± 7.9 at 12 weeks to an average of 92.8 ± 11.1 at 1 year follow up. HRQoL measures showed a pattern of initial drop at 3 months postoperatively, then a steady rise to be restored at 1 year as compared to the preoperative baseline measures. There were no dislocations encountered in this series over one year follow up. The following complications were encountered; 1 deep infection, 2 deep vein thrombosis, 2 heterotopic ossifications, and 1 patient died within one year after surgery. ConclusionsDual mobility cup total hip replacement is an acceptable method for treatment of displaced femoral neck fracture in active middle aged patients in Egypt as it provides pain relief and good function without compromising the stability.

Cementation of a Dual Mobility Construct in Recurrently Dislocating and High Risk Patients Undergoing Revision Total Arthroplasty

BackgroundRecurrent instability remains a challenge after revision total hip arthroplasty (THA). We report the outcomes of cementing a cementless dual mobility (DM) component into a stable acetabular shell for the treatment and/or prevention of instability in revision THA. MethodsEighteen patients (18 THAs) undergoing revision THA with a specific monoblock DM construct cemented into a new acetabular component or an existing well-fixed component from 2011 to 2014 were retrospectively reviewed. Tumor prostheses and total femoral replacements were excluded. In 9 patients (50%), components were implanted specifically for recurrent dislocations. Mean age was 64 years; mean follow-up was 3 years. Patients underwent an average of 4 prior hip operations (range 2-6). ResultsNo cemented DM cups dissociated at the cement-cup interface. Three patients (17%) experienced a postoperative dislocation. One required a revision to constrained liner and 2 underwent open reduction with retention of the DM construct. Harris Hip Scores improved from 53 to 82 postoperatively (P < .001). ConclusionCementation of a monoblock cup DM construct, an off-label use as the construct is not specifically made for cementation, into a well-fixed acetabular component provides an alternative to enhance prosthetic stability in (1) recurrently dislocating THAs with well fixed, well-positioned acetabular components and (2) complex acetabular reconstructions in which constraint should be avoided. While not a perfect solution in this series, DM constructs provide a number of advantages including no added constraint at the interface and a large effective femoral head to diminish prosthetic impingement.

Midterm survival analysis of a cemented dual-mobility cup combined with bone impaction grafting in 102 revision hip arthroplasties.

Revision hip arthroplasty is associated with higher dislocation rates than primary hip arthroplasty. A dual-mobility cup (DMC) can reduce this risk. Another problem is destruction of the acetabulum, induced by aseptic loosening of the prosthesis. Bone impaction grafting (BIG) can be used to reconstruct these defects, but is usually performed with cemented all polyethylene cups. The purpose of this study is to evaluate midterm cup survival and dislocation rate for the combination of BIG and DMC. Between 2007 and 2013, 96 patients received 102 DMCs combined with BIG of the acetabulum during revision surgery. These data were first compared with a control group, consisting of 59 cases from the same hospital receiving a cemented all polyethylene cup combined with BIG. In addition, the control group was expanded with 41 cases operated on in 2007 in 'an orthopaedic centre of excellence', resulting in a 'combined control group' of 100 patients. Log-rank tests and chi-square tests were used to compare survival and dislocation rates, respectively. Cumulative survival of the DMC was 95.8% (range 3 months-7 years). This was comparable to the survival in the control groups (96.5% and 94.7%). The dislocation rate of 2.9% (3/102) in the dual-mobility group was lower (p = 0.02) compared to the dislocation rate of 11.8% (7/59) in the control group, but not (p = 0.12) compared to 8% in the combined control group (8/100). This study shows that combining a DMC with BIG does not compromise outcome in terms of midterm survival of the cup.

Good mid-term clinical results of a cemented dual mobility cup: a single-centre experience.

From January 2004 to December 2008, 188 total hip arthroplasties were performed using a cemented dual mobility cup. 174 patients were available for final analysis. Their mean age was 76.8 (range 54-98 years). The mean follow-up was 7.7 years (range 5-10 years). There were no dislocations. Survivorship rates of the femoral and acetabular components were 100% at a minimum of 5 years. At the latest follow-up, the mean Harris Hip Score significantly increased from 31.6 (only arthritic patients) points preoperatively to 84.5 points. No patients had progressive osteolysis, component migration, or loosening on radiographs. 2 patients presented with periprosthetic fractures treated conservatively. 2 patients presented with infection treated without implant removal and 1 patient presented with transient femoral palsy. The results of this consecutive series confirmed the good performance of the cemented dual mobility cup at mean 7.7 years follow-up with no revision and no dislocations.

Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register

PurposeDislocation after total hip arthroplasty (THA) is a common reason for revision. The last decade fostered a significant increase in the use of dual-mobility cups (DMCs). Here we report our study on the short-term survival rate of a cemented DMC reported to the Swedish Hip Arthroplasty Register (SHAR) compared with other cemented designs used in first-time revision due to dislocation.MethodsDuring 2005–2015, 984 first-time revisions for dislocation were reported to SHAR. In 436 of these cases a cemented dual articular cup was used. During the same time period, 355 revisions performed with a standard cemented cup (femoral head size 28–36 mm) were reported to the SHAR. Patients receiving a DMC were slightly older (75 years, p = 0.005). Re-revision for all reasons was used as primary endpoint. We also anlaysed risk for re-revision of the acetabular component and re-revision due to dislocation. Kaplan–Meier implant survival and a Cox regression analyses adjusted for age and gender were performed.ResultsImplant survival at 4 years for all reasons (91% ± 3.7% vs 86% ± 4.1%, p = 0.02), and especially for re-operation because of dislocation, favours the DMC group (96% ± 3.0% vs 92% ± 3.3%, p = 0.001).DiscussionOur findings indicate that use of a cemented DMC reduces the short- to mid-term risk of a second revision in first-time revisions compared with classic cup designs. Longer follow-up is needed to establish any long-term clinical advantages when DMCs are used in revisions performed due to dislocation.

Can cemented dual-mobility cups be used without a reinforcement device in cases of mild acetabular bone stock alteration in total hip arthroplasty?

IntroductionCemented versions of dual-mobility cups (DMCs), helpful in cases of bone stock alteration, are usually used in association with a reinforcement device. To simplify the intervention in elderly subjects or those with a poor bone stock, the cups can be cemented directly into the bone, but the long-term result remains uncertain. We conducted a retrospective study in this population so as to: (1) assess whether cemented fixation of a DMC without a reinforcement device leads to a higher loosening rate, (2) confirm its efficacy in preventing dislocations in subjects at high risk of instability, and (3) measure the functional results. HypothesisCemented fixation of a DMC is reliable in cases of moderate alteration of bone stock. Material and methodsSixty-four patients (66 hips) undergoing implantation of a cemented DMC (Saturne™) without a reinforcement device were included in this single-center retrospective study. Their mean age was 79.8 years (range, 40–95 years). The indications varied: hip osteoarthritis (30.3%), prosthesis revision (44.0%), and trauma (25.8%). The patients were evaluated radiologically and clinically at follow-up. The main evaluation criterion was the revision rate for aseptic loosening. Dislocations, the infection rate, and the Postel Merle d’Aubigné (PMA) score were noted. ResultsAt the mean follow-up of 4.2 years, three (4.6%) patients had been lost to follow-up and 22 (33.3%) had died. There was one case of aseptic loosening (1.5%). Cup survival was 98% at 5 years (95%CI [94–100]). There were no dislocations. There was one revision for infection. The mean PMA score was 15.5 (range, 9–18). DiscussionThe frequency of acetabular loosening was comparable to the frequency in cemented DMCs with a reinforcement device. A cemented DMC without a reinforcement device is possible and is a simple and viable option when there is moderate bone stock alteration. Level of evidenceIV, retrospective cohort study.

Acetabular Reconstruction Using a Kerboull Cross-Plate, Structural Allograft and Cemented Dual-Mobility Cup in Revision THA at a Minimum 5-Year Follow-Up

The current study aimed to evaluate the outcome of a continuous and prospective series of 61 revision THAs with AAOS grade III and IV acetabular bone defect reconstruction using a Kerboull cross-plate, structural allograft and cemented dual mobility cup (Saturne, Amplitude, Valence, France). At a 7.5-year mean follow-up, no instability was reported after revision. In addition, no failure of the acetabular reconstruction was observed in 98% of the patients with complete allograft osseointegration and no evidence of mechanical rupture of the Kerboull cross-plate and/or loosening of the cemented dual mobility cup. In conclusion, such reconstruction technique demonstrated excellent results at mid-term follow-up in terms of prevention of instability after revision, restoration of the acetabular bone stock, and stable cemented fixation of the dual mobility cup.

Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital

Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup

The main causes of total hip arthroplasty (THA) revisions are loosening and instability. Dual mobility cups were introduced to prevent instability, but their behavior during revisions with acetabular reconstruction has not been assessed. Use of a dual mobility cup cemented in a acetabular reconstruction cage device limits the risk of instability and does not hinder the acetabular fixation during THA revisions. The objective of this study was to test this hypothesis on a retrospective series of 96 revisions. At a mean follow-up of 41 months (range, 1-101 months), we analyzed a continuous series of 96 revisions using a reconstruction device (70 Kerboull™ cross-plates, six Burch-Schneider™ antiprotrusio cages, 20 custom-fit Novae ARM™ cages associated in all cases with a Novae Stick dual mobility cup cemented into the cage). Fifteen patients died at a mean follow-up of 22 months (range, 1-66 months) and four patients were lost to follow-up at a mean follow-up of 16 months (range, 9-27 months). These were acetabular revisons involving major bone loss, with 62 stage III and 26 stage IV cases on the SOFCOT classification. Eighty-seven patients (87.5%) underwent structural bone allografting. The mean Merle d'Aubigné score increased from 9.6 ± 3.06 (range, 2-16) preoperatively to 15.5 ± 2.32 (range, 7-18) at the follow-up. Ten dislocations (10.4%) occurred, five of which were delayed over three months after the index procedure (5.2%), but there were no intraprosthetic dislocations. At the follow-up, the X-rays showed eight hardware failures, including one cross-plate fracture, one hook fracture, and one flange fracture. Analysis of the radiological position of the cup showed a mean lowering of 15.6mm and a 9.4mm lateralization compared to the preoperative position. One revision for aseptic loosening and another for septic loosening were performed. Taking all-cause acetabular component exchange as a criterion, the survival rate at 8 years was 95.6% (95% CI, 93.3-97.7%) and 99.3% (95% CI, 98.9-99.6%) if the endpoint was aseptic acetabular exchange. This study confirms the advantage of dual mobility cups during acetabular reconstruction cemented in antiprotrusio cages as a way to limit, without eliminating, the risk of dislocation. Therefore cemented fixation of dual mobility cups in cages appears to be a reliable short-term option.

The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation: A Prospective Evaluation

Several devices based upon the dual mobility concept have recently emerged. However, little is available on the efficiency of dual mobility in the treatment of THA instability. The purpose of this study was to evaluate the outcome of a cemented dual mobility cup to treat recurrent dislocation.