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

Abstract

Background: The separate design concepts of dual-mobility cups and triple-taper femoral stems were developed to improve survivorship following total hip replacement (THR) by reducing instability/dislocation and enabling enhanced fixation. Successful outcomes at over two decades have been reported with earlier-generation devices based on these concepts. The current study aimed to provide the first long-term results with a unique pairing of later-generation dual-mobility cup and triple-taper cementless femoral stem after a decade of use in patients undergoing THR. Methods: In this retrospective analysis, records were reviewed for all subjects implanted with this dual-mobility cup/cementless femoral stem combination at three centers between 2002 and 2005. Any subject who had not already had follow-up visit beyond 10 years, was not previously revised, and still living were invited for a single follow-up visit consisting of Merle d'Aubgine Scores, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and standard radiographs. Results: There were 244 THRs available for analysis. At a mean follow-up of 11.9 years, the Kaplan-Meier survivorship (endpoint: revision for any reason) was 99.1% (95% CI, 97.6-99.7) for the stem and 95.9% (95% CI, 93.1-97.6) for the cup. Merle d'Aubigne Scores were significantly improved from baseline and WOMAC scores were in the satisfactory range at the final follow-up. Radiographic analysis revealed no cases of stem subsidence, no cases of bone hypertrophy, 1 (0.4%) case of bone atrophy, and 3 (1.2%) cases of osteolysis around the stem. No subjects had radiolucent lines greater than 1 mm in any femoral Gruen zone. Evidence of cup migration was seen in 1 (0.4%) subject and 1 (0.4%) subject had evidence of osteolysis that was seen in Gruen zones I, II, IV, and V. Conclusions: This combination of a later-generation dual-mobility cup and cementless triple-taper stem was associated with excellent survivorship and satisfactory functional outcomes at over 10 years follow-up.

Effect of femoral stem surface coating on clinical and radiographic outcomes of cementless primary total hip arthroplasty: a patient-matched retrospective study

“…Many studies have reported on outcomes of HA-coated stems [1,8,9,28,29], but only a few have reported on outcomes of other coatings. Studies on stems with first plasma-sprayed titanium and then HA coating have reported satisfactory mid-and long-term outcomes [6,[30][31][32], this coating combination may provide stronger biological and mechanical bone fixation compared to only HA coating [6,33,34]. A recent study by Liu et al [35] has shown that a pore size between 50 and 800 μm stimulates bone ingrowth.…”

Survival and performance of a dual tapered-wedge fully HA-coated press fit femoral stem

“…Only two other stems have published survival rates. The survival rate for the Polarstem (Smith and Nephew, Inc Watford, UK) at 5 years is reported to be 99.6% and the Avenir stem (Zimmer-Biomet, Warsaw IN, USA) at 7 years is 98.9% [25,26].…”

Outcomes of dual-mobility total hip arthroplasty versus bipolar hemiarthroplasty for patients with femoral neck fractures: a systematic review and meta-analysis

“…The mean time from index surgery to those symptomatic failures ranged from 34 to 96 months [ 29 ]. A modern generation of DM-THA has been reported with excellent long-term implant survival (more than 95% at 10-year follow-up) [ 30 ]. Since the main objective for most of the included studies was to compare short-term outcome domains, including dislocation, reoperation, functional score, and mortality, the mean follow-up duration ranged from only 12 to 36 months, which was too short to validate and compare implant survival between DM-THA and HA group.…”