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

Abstract

Dislocation 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.

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

“…The full texts of the remaining 86 articles were examined. Finally, according to the eligibility criteria, 56 articles were included in the systematic review [ 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ] ( Figure 1…”

Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty

“…Two were treated with open reduction and 1 with revision to a cemented constrained liner. Evangelista et al [31] assessed the outcomes of 18 patients who underwent cementation of a DM monoblock cup, designed for cementation, into a well-fixed or new revision acetabular cup. At a mean follow-up of 36 months, there were no cases of hip dislocation nor any dissociation at the DM-cement interface.…”

“…Although biomechanical studies have validated the use of cementation of a DM cup into a well-fixed metal acetabular shell as a viable alternative to a standard cemented polyethylene liner, clinical reports evaluating outcomes of this construct in patients at high risk for recurrent instability and dislocation have been equivocal [22], [28], [29], [30], [31]. The goal of this study is to analyze the short-term outcomes, and rates of complications, reoperations, and re-revisions of a DM cup meant for cementation cemented into a newly implanted highly porous revision acetabular shell.…”

Treatment of Severe Acetabular Bone Loss Using a Tantalum Acetabular Shell and a Cemented Monoblock Dual Mobility Acetabular Cup

“…6,14,15 Dual mobility has emerged as a promising treatment option in revision THA to increase stability and decrease dislocation rates. [16][17][18][19][20][21][22] Cemented dual mobility constructs have demonstrated low dislocation rates and no evidence of implant failure when used in conjunction with newly implanted revision shells in recently reported case series. 23,24 Both studies demonstrated low dislocation rates.…”