A Retrieval Analysis of Impingement in Dual-Mobility Liners

Scott, Trevor P.; Weitzler, Lydia; Salvatore, Anthony; Wright, Timothy M.; Westrich, Geoffrey H.

doi:10.1016/j.arth.2018.03.019

Cited by 14 publications

(11 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similarly, the clinical consequence of the PE damage and wear lesions observed in this biomechanical study remains unknown. However, considering that cracks could occurred into the mobile component retentive area during the snap-fit of the femoral head, it might be supposed that such impingement lesions onto the chamfer could rationally induce their propagation with time particularly in case of restricted motion at the large articulation [6,7,[11][12][13][14]24]. Second, the femoral necks were designed and custom-made machined for this study purpose reproducing analog geometries of commercially available implants.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the type II was the most common mechanism of IPD accounting for 51% of the cases with the shortest delay of occurrence compared to type I IPD, which is related to isolated and natural wear of the third articulation in a well-functioning DMC, or type III IPD, which is associated with aseptic loosening of the metal-shell [ 6 ]. Several causes that lead to restricted motion at the large articulation have been reported in literature [ 6 , 7 , 9 , 11 , 12 , 14 ]. They were related (1) to implant-specific characteristics in early generation of DMC such as insufficient clearance between the mobile component and the metal-shell at the large articulation, non-optimal design of the mobile component retentive area and chamfer, or wear performance of the first generations of UHMWPE; and (2) to tissue response to THA such as periprostehtic ossifications, arthrofibrosis, or iliopsoas tendon impingement with the mobile component [ 6 , 7 , 9 , 11 , 12 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several causes that lead to restricted motion at the large articulation have been reported in literature [ 6 , 7 , 9 , 11 , 12 , 14 ]. They were related (1) to implant-specific characteristics in early generation of DMC such as insufficient clearance between the mobile component and the metal-shell at the large articulation, non-optimal design of the mobile component retentive area and chamfer, or wear performance of the first generations of UHMWPE; and (2) to tissue response to THA such as periprostehtic ossifications, arthrofibrosis, or iliopsoas tendon impingement with the mobile component [ 6 , 7 , 9 , 11 , 12 , 14 ]. Therefore, understanding the biomechanical relationship between the femoral neck characteristics and chamfer of the mobile component at the third articulation is of major importance to reduce complications due to wear by selecting optimized implant designs in modern DMC constructs, especially whether restricted motion at the large articulation due to tissue response occurs in vivo with time.…”

Section: Discussionmentioning

confidence: 99%

“…Lecuire et al first emphasized the critical importance of the third articulation in the occurrence of intraprosthetic dislocation (IPD) related to long-term wear of the mobile component chamfer and retentive area [5][6][7]. Retrieval and biomechanical studies further demonstrated that motion and wear predominated at the small and third articulations with potential PE damage and deformation onto the chamfer due to femoral neck impingement, particularly in case of restricted motion at the large articulation [5][6][7][8][9][10][11][12][13][14][15]. In a well-functioning DMC, Nebergall et al and Loving et al reported that, as the mobile component freely moves along three axes, a mobile impingement of the femoral neck occurred onto the mobile component chamfer at the third articulation [14,15].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Which femoral neck for a dual mobility cup? A biomechanical evaluation

Wegrzyn

Longaray

Baez

et al. 2022

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose This study aimed to evaluate polyethylene (PE) damage and wear lesions to the chamfer of mobile components under mobile and fixed femoral neck impingement at the third articulation, and to determine which femoral neck characteristics should be considered with a dual mobility cup to limit those lesions. Methods Two femoral neck geometries (cylindrical and quadrangular) with two surface finishing roughness (rough and polished), and two head-to-neck ratios (28- and 22.2-mm diameter femoral heads) were evaluated in a hip simulator testing. For each characteristic, six femoral necks were tested with six dual mobility cups under fixed and mobile femoral neck impingement conditions. Chamfer PE damage and volumetric wear were evaluated and compared for each femoral neck characteristic and impingement condition. Results Under mobile impingement condition, femoral neck characteristics did not significantly affect PE damage and wear lesions to the chamfer (p = 0.283 to 0.810). However, under fixed impingement condition, significantly higher PE damage and wear lesions to the chamfer were produced by the quadrangular geometry compared to the cylindrical geometry (p = 0.004 to 0.025). In addition, with the quadrangular geometry, rough surface finishing was demonstrated to increase volumetric wear of the chamfer (p = 0.009). No significant influence of head-to-neck ratio was observed on PE damage and wear lesions to the chamfer (p = 0.244 to 0.714). Discussion This biomechanical study emphasized that femoral neck characteristics are critical with dual mobility cup and tend to favor a cylindrical geometry particularly whether fixed impingement at the third articulation occurs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Which femoral neck for a dual mobility cup? A biomechanical evaluation

Wegrzyn

Longaray

Baez

et al. 2022

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…9 A recent retrieval study of hips undergoing revision arthroplasty demonstrated a fourfold reduced incidence of impingement with DM compared with traditional arthroplasty components. 10…”

Section: Kinematics and Design Rationalementioning

confidence: 99%

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

et al. 2018

View full text Add to dashboard Cite

The concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

show abstract