Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Abstract

Background Obesity is associated with an increased risk of dislocation after total hip arthroplasty (THA). However, in patients with obesity, it is not known whether the risk is only in the early postoperative period or whether it persists several years after surgery, and whether having bariatric surgery before undergoing THA and/or receiving a specific device (such as a dual-mobility or constrained acetabular liner) is more effective in terms of decreasing the risk of dislocation. Question/purposes (1) What is the cumulative risk of dislocation in patients with obesity after THA in the absence of a dual-mobility or constrained liner, and is this related to component positioning? (2) Does bariatric surgery before undergoing THA decrease dislocation risk in patients with obesity? (3) Are dual-mobility and constrained liners efficient in preventing dislocation in patients with obesity? Methods At our university-based practice, all surgeons adhered to the following treatment approaches: Before 2000 no dual-mobility implants or constrained liners were used for primary THAs. 2 ) who received standard cups, 85 hips in patients with bariatric surgery before THA using standard cups (with reduction to a BMI \ 30 kg/m 2 ), and 155 hips in patients with obesity who received dual-mobility (when younger than 70 years) or constrained liners (when older than 70 years). All patients received the same implants except for different femoral head diameters (32-mm head with standard cups and 28-mm head with dual-mobility or constrained liners). The patients were followed at routine intervals and were specifically queried about dislocation. All the 670 hips had a minimum followup of 5 years with a mean followup of 14 years (range 5-25 years). At the most recent followup, 101 (15%) hips were lost to followup (respectively, 36 of 215, 34 of 215, five of 85, 24 of 155), which is the same ratio as observed among the underlying populations from which the patients were drawn.Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

“…Similarly encouraging results have been reported with later-generation dual-mobility cups [6][7][8][9][10][11]. The continued positive safety and performance observed with these designs has extended their use into younger, more active patients [12], as well as the obese [13].…”

Total hip arthroplasty for sickle cell osteonecrosis: guidelines for perioperative management

“…Additionally, obesity is associated with increased risk of SCD-related morbidities such as hypertension and is associated with more hospitalizations. For these obese patients and particularly when anatomical abnormalities are present, we used dual mobility implants 53 to prevent dislocation.…”

Identification of risk factors for treatment failure of closed reduction and abduction bracing after first-time total hip arthroplasty dislocation

“…It is well documented that overweight patients are at a higher risk for THA dislocation, because of extraarticular fatty tissue acting as a fulcrum and increasing the risk of soft tissue impingement [33,34]. The mechanisms that lead to this increased risk of THA dislocation are the same as those that lead to recurrent dislocation, despite the use of an abduction brace.…”