The use of dual-mobility bearings in patients at high risk of dislocation

Abstract

Aims Instability continues to be a troublesome complication after total hip arthroplasty (THA). Patient-related risk factors associated with a higher dislocation risk include the preoperative diagnosis, an age of 75 years or older, high body mass index (BMI), a history of alcohol abuse, and neurodegenerative diseases. The goal of this study was to assess the dislocation rate, radiographic outcomes, and complications of patients stratified as high-risk for dislocation who received a dual mobility (DM) bearing in a primary THA at a minimum follow-up of two years. Materials and Methods We performed a retrospective review of a consecutive series of DM THA performed between 2010 and 2014 at our institution (Hospital for Special Surgery, New York, New York) by a single, high-volume orthopaedic surgeon employing a single prosthesis design (Anatomic Dual Mobility (ADM) Stryker, Mahwah, New Jersey). Patient medical records and radiographs were reviewed to confirm the type of implant used, to identify any preoperative risk factors for dislocation, and any complications. Radiographic analysis was performed to assess for signs of osteolysis or remodelling of the acetabulum. Results There were 151 patients who met the classification of high-risk according to the inclusion criteria and received DM THA during the study period. Mean age was 82 years old (73 to 95) and 114 patients (77.5%) were female. Mean follow-up was 3.6 years (1.9 to 6.1), with five patients lost to follow-up and one patient who died (for a reason unrelated to the index procedure). One patient (0.66%) sustained an intraprosthetic dislocation; there were no other dislocations. Conclusion At mid-term follow-up, the use of a DM bearing for primary THA in patients at high risk of dislocation provided a stable reconstruction option with excellent radiographic results. Longer follow-up is needed to confirm the durability of these reconstructions.

Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty

“…Dislocation revisions were common, but case-mix did not seem to matter based on our data. In literature however, advanced age, previous surgery, ASA III-IV, and BMI >30 have been associated with increased risk of dislocation [19]. Based on the results of this study, patient characteristics can be used to help surgeons counsel patients and give a patienttailored advice, in order to decrease the risk for short-term revision after THA.…”

Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

“…The underlying causes of dislocation after THA have been classified by Wera et al [4] into the following six categories: (1) acetabular component malpositioning, (2) femoral component malpositioning, (3) abductor deficiency, (4) impingement, (5) poly wear, and (6) unrecognized aetiology (idiopathic). Instability has been reported as the most common reason for revision surgery after THA in the USA [6]. Factors associated with higher dislocation rates post-THA are small head size; femoral component malpositioning; cup inclination outside Lewinnek`s safe zone (30°-50°); inappropriate anteversion; unrepaired joint capsule; lowvolume surgeon; and patient-specific factors such as neurological deficits (dementia, Parkinson disease), high ASA score, history of spinal fusion, abductor deficiency, body mass index > 35 kg/m 2 , and preoperative Harris Hip Score < 41 [5,[7][8][9][10][11].…”

Dual mobility acetabular construct with freedom constrained liner for treatment of recurrent dislocations after total hip arthroplasty: A case report and literature review

“…Post-THA dislocation is a challenging multifactorial complication with multiple treatment options [ 15 , 16 ]. One such option involves the use of dual-mobility bearings, which are known to improve stability in both primary and revision THA [ [17] , [18] , [19] ]. Terrier et al suggested that dual mobility implants provided the greatest ROM before the risk of impingement and had a lower risk of subluxation and dislocation than standard and constrained implants in finite element analysis [ 20 ].…”