Recurrence of Dislocation Following Total Hip Arthroplasty Revision Using Dual Mobility Cups Was Rare in 180 Hips Followed Over 7 Years

Patrice Mertl, MD
Orthopaedics Department, University of Amiens, France

Antoine Combes, MD
Roger Salengro Hospital, Centre Hospitalier Regional Universitaire de Lille, France

Frederique Leiber-Wackenheim, MD
Orthopaedics Department, University of Amiens, France

Michel Henri Fessy, MD
Department of Orthopaedics, Traumatology and Sports Medicine, Centre Hospitalier Lyon Sud, France

Julien Girard, MD, PhD
Roger Salengro Hospital, Centre nHospitalier Regional Universitaire de Lille, France

Henri Migaud, MD
Roger Salengro Hospital, Centre nHospitalier Regional Universitaire de Lille, France


Abstract

Background 
Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported.

Purpose 
Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects.

Methods 
One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4±11.7 years; range, 19 to 92 years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessment at a mean follow-up of 7.7±2.2 years (range, 4 to 14 years). The rate of survival was calculated considering any reason for revision as failure.

Results 
At follow-up, Harris hip score was 83.9±16.1 (range, 21 to 100). Dislocation of the large articulation occurred in seven hips (4.8%), and only two recurred (1.4%) (one requiring additional revision). In addition, two intra-prosthetic dislocations of the small articulation (1.4%) were observed and needed revision surgery. The large number of earlier surgeries and non-union of the greater trochanter were related to recurrent instability. Two cups (1.4%) showed signs of definite loosening; six (4.1%) presented signs of possible loosening. Twenty-nine hips manifested femoral or acetabular osteolysis (20%), but only three were severe. Eight-year survival rate considering revision for any reason was 92.6% (95% CI, 85.596.4%).

Conclusions 
This series indicates that DM cups are a viable option to treat recurrent THA instability. Their design provides a low risk of recurrent instability without increasing mechanical complications.

This article appears in HSS Journal: Volume 8, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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