Absence of instabilities and intra-prosthetic dislocations at 7 to 11 years following THA using a fourth-generation cementless dual mobility acetabular cup

Abstract

Purpose: Dual-mobility (DM) cups are increasingly used in total hip arthroplasty (THA) but there lacks literature on their long-term results. We aimed to investigate outcomes of a fourth-generation cementless DM acetabular cup at 7-11 years. Methods: We retrospectively evaluated 240 consecutive hips that received cementless THA using the same dual mobility cup (Novae Sunfit TH) and femoral stem (Corail). Patients were recalled at ≥7 years to collect Oxford hip scores (OHS), Harris hip scores (HHS), and inspect for radiolucent lines and granulomas. Multi-variable analyses were performed to determine whether HHS or OHS were associated with pre-or intra-operative variables. Results: At 8.4 ± 0.8 years (range, 7-11), 6 hips were revised (2.5%), 54 deceased (22.5%), and 14 could not be reached (5.8%). Four revisions (2 cup+stem, 2 liners only) were due to sepsis (1.7%), one (cup and stem) for trauma (0.4%), and one (stem) due to aseptic loosening (0.4%). For the remaining 166 hips, HHS was 83.6 ± 13.2 and OHS was 20.3 ± 6.7. Multivariable analysis confirmed that HHS (β = − 0.38; p = 0.039) and OHS (β = 0.36; p < 0.001) worsened with age, and that OHS was worse for Charnley C patients (β = 3.17; p = 0.009). Neither granulomas nor radiolucenies were observed around any cups, but radiolucenies were seen around 25 stems (20.3%). Conclusions: This fourth-generation DM cup demonstrated satisfactory outcomes at 7-11 years, with no instabilities or cup revisions due to aseptic loosening. Better OHS was observed for younger patients and those presenting higher Charnley grade.

Total Hip Arthroplasty Using a Hemispherical Uncemented Dual-Mobility Cup Results in Satisfactory Clinical Outcomes and No Dislocations at 2 years

“…This study demonstrated satisfactory clinical outcomes of uncemented THA using a novel hemispherical DM acetabular cup without a protrusive cylindro-spherical rim, with a cup cumulative revision rate of 0.6%, and a global cumulative revision rate of 1.5%, at a mean follow-up of 2.8 years. While the global cumulative revision rate may seem high at such short follow-up, it is worth noting that some revisions were due to traumatic periprosthetic fractures and that the rate remains within the range reported for other contemporary DM acetabular cups [ 4 , 6 , 7 ]. Numerous smaller series (<100 hips) had no revisions of any kind at 5 to 10 years of follow-up, but larger cohorts (>150 hips) had overall revision rates between 0.5% and 3.6%, at 5 to 13 years of follow-up.…”

“…According to recent literature, sepsis is a common reason for revision of DM cups, and this could be a result of the frailty and comorbidities of the elder population in which they are usually implanted [ 1 , 7 , 15 ]. The present study recorded no revisions due to infection at 2.8-year follow-up, thus comparing favourably to that reported in the Danish Hip Registry for all THA infections (1.0% at 5 years) [ 16 ].…”

“…Contemporary DM cups have proved effective at preventing intraprosthetic dislocation and demonstrated low rates of complications and revisions [ 3 , 4 ]. DM cups were originally designed to prevent dislocations in elderly patients or those with femoral neck fractures [ 3 , 5 , 6 ] but are increasingly implanted for a broader range of indications [ 3 , 7 ]. Ilio-psoas impingement remains a matter of concern with DM cups because they are more likely to overhang at the anterior margin of the acetabulum, as their design features a protrusive cylindro-spherical rim to increase the jump distance [ 8 ].…”

Is Cemented Dual-Mobility Cup a Reliable Option in Primary and Revision Total Hip Arthroplasty: A Systematic Review

“…The clinical and radiographic outcomes of cementless DMCs are excellent at medium and long follow-ups with an overall survivorship of 95% at 10-year follow-ups and demonstrated low revision and dislocation rates, without major polyethylene wear concerns [ 16 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ].…”

Intraprosthetic dislocation after a revision hip replacement: a case report

“…9,14 The available literature that was reviewed shows no cases of early IPD occurring in patients with a femoral head smaller than 28 mm or in patients in which the DMC was used in conjunction with a skirted femoral head. 9 Chouteau et al 19 reported no cases of IPD in their cohort of 240 fourth-generation DMCs at 7-to 11-year follow-up, highlighting the rarity of the complication in modern designs and ultra-high molecular weight polyethylene. The potential for polyethylene wear with subsequent IPD still exists and may present several years after implantation.…”