The use of a dual-articulation acetabular cup system to prevent dislocation after primary total hip arthroplasty: analysis of 384 cases at a mean follow-up of 15 years

Abstract

The concept of a dual articulation acetabular cup was developed by Prof. Bousquet in 1974. This concept has been shown to provide high stability after revision and primary total hip arthroplasty. The aim of our study was to evaluate the incidence of prosthetic instability in a consecutive homogeneous series of 384 primary dual mobility cups. Incidence of instability and implant survival were evaluated. Mean follow-up was 15.3 years (range, 12-20). There was no early or late instability. On the acetabular side there were 13 aseptic loosenings, 14 intraprosthetic dislocations, and seven polyethylene wear cases that required replacement of the liner. The cumulative survival rate of the dual-articulation acetabular cup using surgical revision for aseptic loosening as the endpoint was 95.9%±4.1% at 18 years postoperatively. Our series proves the good long term behaviour of dual-articulation acetabular components in primary arthroplasty. Their excellent survivorship rate and the absence of episodes of prosthetic instability increase our confidence in this concept. Résumé Le concept de cupule à double mobilité a été inventé par le Professeur Gilles BOUSQUET en 1974. Ce concept a permis de mettre en évidence une importante stabilité des hanches, notamment après révision mais également dans les prothèses totales de hanches de première intention. Le but de cette étude est d'évaluer l'incidence et l'instabilité sur une série homogène consécutive de 384 hanches traitées avec cupule à double mobilité. Le taux d'instabilité des implants sur les patients survivants a été évalué. Le suivi moyen a été de 15,3 ans (de 12 à 20 ans) au plus long recul, il n'y a aucune instabilité ni primaire, ni tardive. Par contre, il existe 13 descellements aseptiques acétabulaires, 14 luxations intra prothétiques, 7 usures du polyéthylène qui ont nécessité un remplacement du PE. Le taux de survie cumulé de cette cupule à double mobilité est de 95,9%±à 18 ans si l'on prend comme critère la révision pour descellement aseptique. Cette série prouve le bon devenir à long terme de cette articulation dans les prothèses totales primaires, avec un excellent taux de survie et l'absence de phénomènes de luxation inhérentes à ce concept.

Low Frequency of Early Complications With Dual-mobility Acetabular Cups in Cementless Primary THA

“…Dual-mobility articulations may help decrease instability after THA [3,5,6,8,10,11,13,15,16,20,24,26]. This is likely the result of the increased effective size of the femoral head as well as the expanded impingement-free ROM.…”

“…Several other studies have also illustrated good aseptic survivorship and lower dislocation proportion with the use of dual-mobility articulations in primary THAs (Table 2). In an analysis of 384 dual-mobility hips, Philippot et al [24] observed a 4% dislocation proportion and cup survivorship of 97% at a minimum followup of 12 years. Similarly, Farizon et al [13] conducted a study examining 135 cementless dual-mobility hips and found a 0.7% dislocation proportion at a minimum followup of 10 years with 95% implant survivorship at 12 years.…”

“…National registries may also help to inform this choice, and we look forward with interest to reports of the world's registries on this topic. Until or unless such studies show the superiority of dual-mobility designs for primary THA, we recommend that in the setting of uncomplicated primary THA, dualmobility articulations be used only in centers that track their results carefully or in research protocols [3,5,6,8,10,11,13,15,16,20,24,26]. Future research should be prospective, comparative, include larger sample sizes, and have longer term followup to evaluate the true outcomes of modular dual-mobility articulations.…”

“…These articulations work by containing a three-component and three-joint system: a socket, a free (not fixed) polyethylene liner, and a head. Dual-mobility articulations are commonly used in the revision setting [17]; however, there is a relative paucity of studies evaluating their use in primary THA [3,5,6,8,10,11,13,15,16,20,24,26]. The present study similarly evaluates a dual-mobility articulation; however, it is different in design from most of the aforementioned studies.…”

The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation

“…Since this early period, a number of cemented and cementless designs have emerged in Europe, and some have been recently Food and Drug Administration-approved. Several studies have assessed the outcome of such devices in the prevention of dislocation in both primary and revision THAs [3,14,22,28,29,[37][38][39][40] and reported very low dislocation rates. Only two studies have assessed a dual mobility socket in the treatment of recurrent dislocation [21,30].…”