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

Chalmers, Brian P.; Ledford, Cameron K.; Taunton, Michael J.; Sierra, Rafael J.; Lewallen, David G.; Trousdale, Robert T.

doi:10.1016/j.arth.2017.11.055

Cited by 48 publications

(51 citation statements)

References 32 publications

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“…Over the years, advances in implant design and technique have built on the Harrington method to include the use of structural allografts, endoprostheses, and acetabular cage constructs . Additionally, dual‐mobility bearings are being increasingly utilized in unique and innovative ways to salvage failed primary THAs by cementing dual mobility cups into well‐fixed acetabular shells . Obtaining stable implant fixation and ultimately functional improvement remains a difficult challenge in patients with large osseous acetabular defects secondary to periacetabular metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease

Plummer

Passen

Alexander

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Large acetabular defects secondary to metastatic disease frequently require extensive acetabular reconstruction. Techniques of acetabular reconstruction have been described, but no consensus for the management of these defects has been reached so far. We present our technique and patient outcomes for acetabular reconstruction by cementing a dual mobility cup into an acetabular cage. Methods We reviewed 152 total hip arthroplasties and identified 19 patients with periacetabular metastatic disease and large defects who required acetabular reconstruction utilizing a dual mobility cup cemented into an acetabular reconstructive cage. The following outcomes were evaluated: pain relief, functional improvement, postoperative complications. Results Mean follow‐up was 3 years, with 13 of the 19 patients eligible for 2‐year follow‐up. Patients reported a significant improvement in both pain and functional outcomes. There were no dislocations or signs of loosening. Two patients developed postoperative infections. One patient required hemipelvectomy 16 months postop due to recurrence of metastatic disease. Conclusions Cementing a dual mobility cup into an acetabular cage provides a highly stable and durable option for patients with periacetabular metastatic disease and large defects. Patients are able to return to immediate full weight bearing with significant improvement in both function and pain at 2 years.

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Section: Discussionmentioning

confidence: 99%

Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease

Plummer

Passen

Alexander

et al. 2019

Journal of Surgical Oncology

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“…However, exact acetabular component position that is ideally suited for each patient is unknown and may change over time [ [5] , [6] , [7] , [8] ]. As such, dual-mobility (DM) articulations, a construct which increases impingement-free range of motion by adding a second articulation and increasing the effective femoral head size and jump distance, have become attractive options for surgeons to mitigate the risk of hip instability [ [9] , [10] , [11] , [12] , [13] , [14] , [15] ].…”

Section: Introductionmentioning

confidence: 99%

Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

2020

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Background: With dislocation as a leading cause for revision after total hip arthroplasty (THA), modular dualmobility (MDM) constructs are more commonly used at present in an attempt to decrease postoperative instability. With modularity, there is potential for additional complications, including malseating of the liner. The goal of this study was to perform a radiographic analysis on the incidence of MDM liner malseating. Methods: We retrospectively identified 305 patients (305 THAs) who underwent primary THA with an MDM liner from a single manufacturer inserted by a single surgeon. One hundred fifty-six (51%) patients were male. The mean age was 68 years, and the mean body mass index was 31 kg/m 2. Only patients with both anteroposterior and cross-table lateral radiographs at a minimum of 6 weeks postoperatively were included. Dislocations and reoperations were determined at 1 year after the procedure. All MDM liners were routinely tested intraoperatively with a "4-quadrant test" to assess for proper seating. Results: Four (4/305, 1.3%) MDM liners were noted to be radiographically malseated at early follow-up with three (3/147, 2.0%) occurring in a thinner two dimentional (2D) ongrowth shell and only one (1/ 158, 0.6%) observed in a thicker three dimentional (3D) additively manufactured shell. They were inferiorly prominent by a median of 1.2 mm, best seen on the cross-table lateral radiograph. In patients with at least 1-year follow-up, no MDM liners dissociated and no patients sustained a dislocation. Five (1.6%) patients required reoperation unrelated to the acetabular or MDM construct. Conclusions: Surgeons should be aware that malseating of dual-mobility liners may occur. However, with utilization of a consistent surgical technique to test for seating of the liner, the radiographic incidence of MDM liner malseating was low at 1%. Although there were no short-term clinical implications of liner malseating, long-term follow-up is needed.

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“…The spinopelvic immobility in these patients can lead to bony impingement, causing postoperative instability [ 8 , 10 ]. As DM constructs provide a greater range of motion to impingement and a larger jump distance, they have become attractive options in patients at high risk of impingement and dislocation [ [19] , [20] , [21] , [22] ]. In the present study, a series of high-risk patients who underwent spinal fusion and posterolateral primary THA with a DM construct did not experience any postoperative dislocations at a mean follow-up of 3 years (range, 1-7 years), even with a range of acetabular component positioning.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple systematic reviews and case series report reduced dislocation rates of DM constructs in high-risk patients undergoing primary and revision THAs [ [19] , [20] , [21] , [22] ]. DM constructs increase the effective impingement-free range of motion, which is the etiology of dislocation in patients who underwent spinal fusions, by adding a second articulation and increasing the effective femoral head size and jump distance [ [19] , [20] , [21] , [22] ]. However, there is a paucity of data on the outcomes of DM constructs in patients who underwent a prior spinal fusion.…”

Section: Introductionmentioning

confidence: 99%

Dual-Mobility Constructs in Primary Total Hip Arthroplasty in High-Risk Patients With Spinal Fusions: Our Institutional Experience

et al. 2020

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Background: Prior spinal fusion significantly increases the risk of dislocation in patients after total hip arthroplasty (THA). Owing to these high risks, surgeons may use dual-mobility (DM) constructs in these patients to optimize hip stability. However, there is a paucity of data on the outcomes of DM constructs in patients who underwent prior spinal fusions. Methods: We retrospectively identified 80 patients (86 THAs) who underwent a spinal arthrodesis and a subsequent posterior approach THA with a DM construct. The median number of levels fused was 4, with 59 (74%) patients having 2 or more levels fused; in addition, 50 (63%) patients were fused to the sacrum. Ninety percent and 55% of THAs were within the Lewinnek safe zone for inclination and anteversion, respectively. Patients were evaluated for any episode of hip instability, complications, and patient reported outcome measures. Results: At 3-year mean follow-up, no patients sustained a postoperative dislocation or intraprosthetic dislocation (0%). Overall, there were 6 (7.5%) complications during the study period leading to reoperation in 3 (4%) patients, none related to the acetabular component or instability. Hip Injury and Osteoarthritis Outcome Score, Joint Replacement scores significantly improved from a mean of 50 preoperatively to 87 postoperatively (P < .001), and the Veterans Rand 12 Item Health Survey physical score improved from a mean of 31 preoperatively to 44 postoperatively (P < .001). Conclusion: In a high-risk series of patients who underwent prior spinal fusion, posterolateral primary THA with a DM construct demonstrated no dislocations at mean 3-year follow-up. Although these early data are clearly encouraging, more patients with longer term follow-up are needed.

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

Cited by 48 publications

References 32 publications

Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease

Rapid return to function and stability with dual mobility components cemented into an acetabular reconstructive cage for large osseous defects in the setting of periacetabular metastatic disease

Modular Dual-Mobility Liner Malseating: A Radiographic Analysis

Dual-Mobility Constructs in Primary Total Hip Arthroplasty in High-Risk Patients With Spinal Fusions: Our Institutional Experience

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