Dual-Mobility Articulations for Patients at High Risk for Dislocation

Plummer, Darren R.; Christy, Jonathan M.; Sporer, Scott M.; Paprosky, Wayne G.; Valle, Craig J. Della

doi:10.1016/j.arth.2016.03.021

Cited by 83 publications

(66 citation statements)

References 37 publications

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“…Obtaining stable implant fixation and ultimately functional improvement remains a difficult challenge in patients with large osseous acetabular defects secondary to periacetabular metastatic disease. Dual mobility bearings provide greater ROM, a greater head‐to‐neck ratio, and a physiologic head size ultimately offering greater resistance to dislocation Our findings are similar to other studies showing patients treated, by cementing dual mobility cups into an acetabular cage, with this technique are able to return to full ambulatory status and have low rates of dislocation and or revision …”

Section: Discussionsupporting

confidence: 86%

“…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%

“…Dual mobility bearings have been used in both primary and revision THA with successful functional outcomes and low dislocation rates . The dual‐mobility design affords a greater range‐of‐motion (ROM), a greater head‐to‐neck ratio, thus reducing impingement and a larger effective femoral head size that increases jump distance and ultimately decreases the risk of dislocation. Several studies have shown dual‐mobility bearings to be an effective option in complex primary and revision THA to prevent or treat instability .…”

Section: Introduction/backgroundmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introduction/backgroundmentioning

confidence: 99%

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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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“…Gwam et al conducted an epidemiological survey using the National Inpatient Samples (NIS) database and found that dislocation‐related acetabular revision occurs in 24.7% of the cases out of 53,508 cases requiring revision surgery. One of the strategies employed to reduce the risk of dislocation in high‐risk patients is to incorporate a dual‐mobility articulation . As the number of THAs has risen each year, the risk of dislocation has remained more or less constant.…”

Section: Introductionmentioning

confidence: 99%

In vitro test methods for seating and fretting corrosion behavior of modular metal‐on‐metal acetabular tapers

Shenoy

Gilbert

2019

Journal Orthopaedic Research

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Retrieval studies show that metal-on-metal acetabular shell-liner tapers are susceptible to corrosion, which is hypothesized to arise from mechanically-assisted crevice corrosion (MACC). The role of materials on MACC of acetabular tapers has not been previously studied. In vitro tests of seating, pushout, and fretting corrosion performance of acetabular tapers are presented to assess the role of material combinations (Ti-6Al-4V shells, HC CoCrMo, LC CoCrMo, and 316L SS liners). The acetabular tapers were wetassembled to a seating load of 1,000 N. The liner load-displacement seating mechanics were measured. Fretting corrosion currents were evaluated using a uniaxial incremental cyclic compression test up to 4,000 N, with the load applied at a 55°angle to the taper interface. Fretting currents, fretting onset loads, taper disengagement strength were measured and load-displacement plots were obtained. Pushout tests were also performed pre-and post-fretting corrosion. The average liner seating displacements varied from 134 to 226 μm across groups. Fretting currents at 3,600 N cyclic load were low and ranged between 0.05 and 0.27 μA and were independent of material combination (p > 0.05), reflecting small amounts of fretting. Fretting corrosion onset loads were between 1,800 and 2,100 N, and did not differ across groups (p > 0.05). Pushout loads were 27-43% of the maximum load applied. Fretting corrosion levels were very low for all material combinations and not different from one another. The seating and pushout responses were also not material dependent. The low fretting currents measured imply that MACC may not be a major cause for acetabular taper corrosion.

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“…4 In contradistinction, Plummer et al reported that of the three dual-mobility modular liners cemented into shells in their cohort, two failed within a short time frame. 5 In the present study, we report on the use of a dualmobility acetabular shell, made specifically for use with cement, which was cemented into a metal shell at the time of revision surgery. Our hypothesis is that for patients at high risk of instability (such as rTHA revision), the dual-mobility bearing would confer increased stability without any complications related to the cementation of the liner or the bearing itself.…”

mentioning

confidence: 99%

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

et al. 2018

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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.

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Dual-Mobility Articulations for Patients at High Risk for Dislocation

Cited by 83 publications

References 37 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

In vitro test methods for seating and fretting corrosion behavior of modular metal‐on‐metal acetabular tapers

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

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