Increase in Safe Zone Area of the Acetabular Cup Using Dual Mobility Cups in THA

2017 ◽  
Vol 27 (4) ◽  
pp. 361-367 ◽  
Author(s):  
Takaaki Ohmori ◽  
Tamon Kabata ◽  
Toru Maeda ◽  
Yoshitomo Kajino ◽  
Tadashi Taga ◽  
...  
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
Safe Zone ◽  
Stable Range ◽  
Dual Mobility Cup ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
Computed Tomography Images ◽  
Revision Tha ◽  
Dual Mobility Cups

Background Dual mobility cup (DMC) inserts reduce the risk of dislocation after total hip arthroplasty (THA). No available research has clearly delineated stability advantages of DMC inserts in primary and revision THA. We investigated: (i) the degree of change in the safe zone of the cup when a DMC insert is used compared to a fixed insert; (ii) the method of selecting candidates for a DMC insert without changing the position of the acetabular (cup) component during revision THA in frequent dislocation cases caused by implant impingement. Methods A model of the pelvis and femur was developed from computed tomography images. The safe zone was defined as the area in the acetabular component, over which conditions for stable range of motion were satisfied. The safe zone was calculated for both a fixed and a DMC insert over a predetermined range of 3-D motion, and the effect of increasing the anteversion position of the femoral component from 5° to 35° was quantified. Results The lowest ratio of the area of the safe zone was about 4.9 at 20° anteverison of the femoral component. Safe zone of DMC inserts zone had increased stability of 10°-15° in both vertical and horizontal directions, compared to fixed inserts. A 5- to10-fold expansion of the safe zone can be expected with the use of DMC insert. Conclusions DMC insert could help to set the acetabular component more accurately in primary and revision THA.

Early Complications of using Dual Mobility Cup in Total Hip Arthroplasty. A Systematic Review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Khairy Mahmoud ◽  
Saleh Gameel Mansour ◽  
Ibrahim Barsoum Anis
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Early Complication ◽  
Dual Mobility Cup ◽  
Early Complications ◽  
Dual Mobility ◽  
Search Results ◽  
Revision Tha ◽  
Dual Mobility Cups ◽  
Cup Arthroplasty

Abstract Background Total hip arthroplasty (THA) is considered one of the most successful surgical procedures providing pain relief and improvement of function in patients with end-stage hip arthritis that does not respond to non-operative treatments. As health care continues to improve and life expectancy increases, the demand for total joint replacement will grow to reflect this more active, aging population. Objectives This study aims to review early complications of dual mobility cup arthroplasty. The objective is to perform a systematic review of early complications of dual mobility cup arthroplasty for primary and revision cases. Methodology Types of studies we will include randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies, and we will exclude case reports, case series studies, cross sectional studies, non English studies. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: THA, Dual mobility cup, complications, intraprosethetic dislocation. Results Early complication rate in dual mobility cups is significantly higher in revision cases compared to primary cases, with the exception of IPD which was significantly lower in revision cases. Early complication rate of conventional THA was significantly higher than both primary and revision dual mobility cups. Conclusion Dual mobility THAs are a good alternative to traditional bearing surfaces with long survivorship and low rates of instability after primary and revision THA. The rate of complications which are unique to the procedure, including intraprosthetic dislocation, is relatively low and limited mainly to earlier designs. High-quality, prospective, comparative studies are needed to further evaluate the use of dual mobility in primary and revision THA.

Dual-Mobility Cup and Cemented Femoral Component: 6 Year Follow-Up Results

2011 ◽  
Vol 21 (6) ◽  
pp. 713-717 ◽  
Author(s):  
Jean Louis Prudhon
Keyword(s):  
Femoral Component ◽  
Femoral Stem ◽  
Implant Survival ◽  
Dual Mobility Cup ◽  
Acetabular Cup ◽  
Low Friction ◽  
Dual Mobility ◽  
Primary Hip Arthroplasty ◽  
Lateral Decubitus

Use of a dual-mobility acetabular cup is associated with a lower risk of dislocation compared with conventional hip implants. The seleXys® DS acetabular cup combines the advantages of Charnley low-friction arthroplasty with those of dual mobility. We performed a non-randomised, prospective study of patients receiving primary hip arthroplasty, including an uncemented seleXys® DS dual-mobility acetabular cup with hydroxyapatite coating (Mathys AG, Bettlach, Switzerland) and a cemented femoral component (Stallion femoral stem Groupe Lepine, Lyon, France). The objective of the study was to evaluate longevity of the implant and the risk of dislocation. All operations were performed by a single surgeon using a posterior approach, with patients lying in the lateral decubitus position. The stem had a modular head diameter of 22.2 mm and was cemented in all patients. A total of 53 patients were studied, and the median duration of follow-up was 78.9 months. Implant survival 6 years after surgery was 98.4% (n=47; 95% CI: 89.3–99.8). There was one revision for sepsis 29 months after surgery, and one dislocation. The results of this study appear to demonstrate excellent implant survival and a low rate of dislocation using the chosen implants.

scholarly journals Polyethylene wear of dual mobility cups: a comparative analysis based on patient-specific finite element modeling

2022 ◽  
Author(s):  
Julien Wegrzyn ◽  
Alexander Antoniadis ◽  
Ehsan Sarshari ◽  
Matthieu Boubat ◽  
Alexandre Terrier
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Finite Element Modeling ◽  
Acetabular Component ◽  
Patient Specific ◽  
Volumetric Wear ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Element Modeling ◽  
Dual Mobility Cups

Abstract Purpose Concerns remain about potential increased wear with dual mobility cups related to the multiple articulations involved in this specific design of implant. This finite element analysis study aimed to compare polyethylene (PE) wear between dual mobility cup and conventional acetabular component, and between the use of conventional ultra-high molecular weight PE (UHMWPE) and highly cross-linked PE (XPLE). Methods Patient-specific finite element modeling was developed for 15 patients undergoing primary total hip arthroplasty (THA). Five acetabular components were 3D modeled and compared in THA constructs replicating existing implants: a dual mobility cup with a 22.2-mm-diameter femoral head against UHMWPE or XLPE (DM22PE or DM22XL), a conventional cup with a 22.2-mm-diameter femoral head against UHMWPE (SD22PE) and a conventional cup with a 32-mm-diameter femoral head against UHMWPE or XLPE (SD32PE or SD32XL). Results DM22PE produced 4.6 times and 5.1 times more volumetric wear than SD32XL and DM22XL (p < 0.0001, Cohen’s d = 6.97 and 7.11; respectively). However, even if significant, the differences in volumetric wear between DM22XL and SD32XL as well as between DM22PE and SD22PE or SD32PE were small according to their effect size (p < 0.0001, Cohen’s |d|= 0.48 to 0.65) and could be therefore considered as clinically negligible. Conclusion When using XLPE instead of UHMWPE, dual mobility cup with a 22.2-mm-diameter femoral head produced a similar amount of volumetric wear than conventional acetabular component with a 32-mm-diameter femoral head against XLPE. Therefore, XLPE is advocated in dual mobility cup to improve its wear performance.

Iatrogenic Intraprosthetic Dislocation of Dual Mobility Cup. Case Study

2021 ◽  
Vol 23 (1) ◽  
pp. 51-57
Author(s):  
Kamil Kurczyński ◽  
Artur Pepłoński ◽  
Piotr Cieślik ◽  
Marta Burbul(
Keyword(s):  
Closed Reduction ◽  
Rare Complication ◽  
Medical Institute ◽  
Dual Mobility Cup ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
First Case ◽  
The Military ◽  
Intraprosthetic Dislocation

Intra-prosthetic dislocation of the dual-mobile acetabular cup is a rare complication. Most often, it is the result of wear of the polyethylene liner. It can also occur during a closed reduction of a dislocated dual-mobile cup. It is extremely important to recognize this complication immediately in order to avoid the consequences. This paper presents the first case of iatrogenic intraprosthetic dislocation at the Traumatology and Orthopaedics Department of the Military Medical Institute, our management of the case and suggestions for treating patients with a dislocation of the dual-mobile acetabular cup.

Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency

2018 ◽  
Vol 28 (5) ◽  
pp. 491-497 ◽  
Author(s):  
Vahit E Ozden ◽  
Goksel Dikmen ◽  
Burak Beksac ◽  
Remzi Tozun
Keyword(s):  
Acetabular Reconstruction ◽  
Dual Mobility Cup ◽  
Survivorship Analysis ◽  
Dual Mobility ◽  
Total Hip ◽  
Kaplan Meier ◽  
Dual Mobility Cups ◽  
The Mean ◽  
Cemented Cup

Introduction: The purpose of this study was to summarise the performance of dual-mobility cup systems for revision total hip arthroplasty in patients with abductor-trochanteric complex deficiency. Methods: We prospectively followed 17 patients (20 hips) with a mean age of 64.5 years (range 33-89 years) who underwent acetabular reconstruction with dual-mobility cups for aseptic loosening in 12 hips, infection treatment as second or single stage in 6 hips, and instability in 2 hips. All of the patients had abductor insufficiency. We evaluated the clinical Harris Hip scores (HHS) and radiographs for migration, loosening, and osteolysis. The survival of the components was calculated according to Kaplan-Meier survivorship analysis, and failure was defined as any dislocation, acetabular component or total hip revision for any reason. Results: The mean duration of follow-up was 38.1 months (range 24-98 months). There were 2 (12.5%) revisions for cemented cup migration after 11 months and 19 months respectively. There were no dislocations. At the last follow-up, the mean HHS increased from 42 points preoperatively to 86 points. The cumulative survival rate of the dual-mobility cup system was 93% (95% confidence interval 88-98.7%) at 5 years, with any revision as the end point. Conclusion: Dual-mobility cups may provide excellent stability in patients with abductor-trochanteric complex insufficiency.

Minimum 7-Year Outcomes of Dual Mobility Acetabular Cups in Total Hip Arthroplasty Patients

2020 ◽  
Vol 04 (02) ◽  
pp. 090-093
Author(s):  
John M. Tarazi ◽  
Hytham S. Salem ◽  
Joseph O. Ehiorobo ◽  
Nipun Sodhi ◽  
Luke J. Garbarino ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Study Cohort ◽  
Dual Mobility Cup ◽  
Dual Mobility ◽  
Total Hip ◽  
Patient Reported ◽  
Dual Mobility Cups ◽  
Metallic Liner

AbstractModular dual mobility cups have been developed to potentially address postoperative hip instability, which can occur in nearly 20% of all revision total hip arthroplasty (THA) patients. By having a prosthetic construct that contains two points of articulation between the femoral head and liner and between the liner and shell, joint stability can be increased. The purpose of this study was to report on dual mobility cup survivorships, patient satisfaction outcomes, complications, and radiographic outcomes at a minimum 7-year follow-up. A high-volume academic surgeon performed a total of 143 consecutive dual mobility primary THAs on patients who had a minimum follow-up of 7 years (range, 7–8.5 years). The study cohort consisted of 77 females (54%) and 66 males (46%) who had a mean age of 65 years (range, 34–90 years). Aseptic, septic, and all-cause survivorship was determined by Kaplan-Meier analysis. Harris Hip Scores (HHS), postoperative complications, and radiographs were also assessed. No cup failures were observed. Overall, septic survivorship was 99.3% (95% confidence interval [CI]: 0.98–1.0) and all-cause survivorship was 98.6% (95% CI: 0.97–1.0). Two patients (1.4%) required revision surgery unrelated to the use of a modular dual mobility cup. Of these, one patient experienced femoral stem loosening and the other developed a periprosthetic infection that was treated with a two-stage revision. The mean total HHS was above 95 points at the most recent follow-up. Three patients (2.3%) experienced medical complications, including two deep vein thromboses and one for nonfatal pulmonary embolism. Radiographic evidence revealed incomplete seating of the metallic liner in one patient. Dual mobility cups were developed in an attempt to decrease the rate of instability following THA. The results from this study indicate that excellent clinical and patient-reported outcomes can be achieved at 7-year follow-up in patients who undergo THA with a dual mobility cup. Therefore, dual mobility cups appear to be an appropriate treatment option for primary THA.

scholarly journals Dual mobility versus unipolar total hip arthroplasty for neck of femur fractures: a single centre study

2021 ◽  
Vol 87 (1) ◽  
pp. 35-39
Author(s):  
Zain Sadozai ◽  
Richard Limb ◽  
Syed Awais Bokhari ◽  
Aaron Ng ◽  
Manjit Bhamra
Keyword(s):  
P Value ◽  
National Guidelines ◽  
Acetabular Cup ◽  
Single Centre ◽  
Neck Of Femur ◽  
Dual Mobility ◽  
Total Hip ◽  
Femur Fractures ◽  
Dual Mobility Cups ◽  
The Cost

Current national guidelines (NICE) recommends that all medically fit, independently-mobile patients without cognitive impairment receive a total hip arTHAoplasty(THA) for displaced intracapsular neck of femur (NOF) fractures. Dislocation is a concern(2-10%). Dual mobility cups have been suggested to address this complication. Our study sets out to compare dislocation rates between dual mobility cups versus unipolar cups. We performed a retrospective single centre multiple surgeon study of all THAs performed for NOFs between January 2012 and May 2018. A total of 322 total hip replacements (127 dual mobility and 195 unipolar ; Age range of patients, 29 to 91, mean 70 years) were identified for analysis using a database. Data was obtained from electronic patient records and radiographs. 12 patients sustained a dislocation of their THA out of our 322 patients. Of these, 10 dislocations occurred in the unipolar group (5.13%). From the dual mobility cups, 2 had dislocations(1.57%), both with a 28mm head. Both of these dislocations were in alcohol dependent patients with increased susceptibility to falls. Statistical analysis of our data was performed using chi-squared test (p value = 0.0723) In ‘Getting It Right First Time’ (GIRFT), the authors recommend that all patients that sustain a NOF fracture meeting the criteria of a THA to be offered a dual mobility acetabular cup to reduce the risk of dislocation. The cost of the dual mobility acetabular cup is offset from the cost of overall revision surgery. Limitations of our study are its retrospective nature and selection bias.

scholarly journals Revision of Metal-on-metal Hip Arthroplasty with Well Fixed and Positioned Acetabular Component Using a Dual-mobility Head and Review of Literature

2016 ◽  
Vol 10 (1) ◽  
pp. 512-521 ◽  
Author(s):  
Guillem Figueras ◽  
Ramón Vives Planell ◽  
Ramón Serra Fernàndez ◽  
Joan Camí Biayna
Keyword(s):  
Femoral Component ◽  
Acetabular Component ◽  
Young Patients ◽  
Bone Stock ◽  
Cobalt Chromium ◽  
Hip Revision ◽  
Dual Mobility ◽  
Metal On Metal ◽  
Hip Arthroplasties

Background: As a consequence of use of metal-on-metal hip arthroplasties some patients have precised revision for pain or metal hipersensivity reactions among other causes. We propose to salvage monoblock acetabular component and femoral component using a dual-mobility head and perform a lower morbidity operation in young patients preserving host bone stock in cases with well fixed and positioned components. Objective: (1) What clinical problems have been reported in patients with Metal-on-metal hip arthroplasties? (2) Could the tribocorrosion potentially cause a fracture of neck femoral component? (3) Can be the dual-mobility head a recourse in metal-on-metal hip revision? Methods: Ten patients were revised for pain or/and raised Cobalt/Chromium levels between August 2012 and December 2015. In three cases femoral neck component was fractured and femoral revision was necessary. In four hips, acetabular and femoral components could be maintained. Age, body index mass, ion levels, acetabular position, size of acetabular component and femoral head, approach, blood transfunsion and time of hospitalization were analized. Results: At a mean follow-up of 25,6 months (6 to 45) the mean postoperative HHS was 92. It was not statistically significant because several patients were low sintomatic before surgery, but had raised Cobalt/Chromium levels in the blood. All patients had near-normal levels of Cobalt/Chromium during the first 6 months after revision surgery. No relevant complications were reported. Conclusion: The use of dual-mobility head can be an acceptable option to revise metal-on-metal arthroplasties correctly oriented with abscence of loosening or infection signs and keeping bone stock in young patients.

scholarly journals Well-Placed Acetabular Component Oriented Outside the Safe Zone During Weight-Bearing Daily Activities

2021 ◽  
Vol 9 ◽  
Author(s):  
Nan Zheng ◽  
Xiangjun Hu ◽  
Dimitris Dimitriou ◽  
Kerong Dai ◽  
Tao Guo ◽  
...  
Keyword(s):  
Acetabular Component ◽  
Mechanical Performance ◽  
Weight Bearing ◽  
Safe Zone ◽  
Daily Activities ◽  
Acetabular Anteversion ◽  
Acetabular Cup ◽  
Acetabular Orientation ◽  
Level Walking

Background: A comprehensive and thorough understanding of functional acetabular component orientation is essential for optimizing the clinical outcome after total hip arthroplasty (THA). This study aimed to quantify the functional acetabular anteversion and inclination of unilateral THA patients during walking and static standing and to determine whether the functional acetabular orientation falls within the Lewinnek safe zone.Methods: Seventeen patients with unilateral THA received a CT scan and dual fluoroscopic imaging during level walking and static standing to evaluate in vivo hip kinematics. The pelvic functional coordinate system of the 3D CT-based computer model was defined by the line of gravity and anterior pelvic plane (APP) to measure functional acetabular anteversion and inclination in different postures. The Lewinnek safe zone was used to determine the acetabular malposition during functional activities.Results: The THA side demonstrated an average of 10.1° (± 9.6°, range –7.5° to 29.9°) larger functional anteversion and 16.0° (± 9.2°, range –7.2° to 29.9°) smaller inclination than native hips during level walking. Functional acetabular anteversion in the THA side during level walking and static standing was significantly larger than anatomical measurements (p &lt; 0.05). Acetabular orientation of most well-placed THA components anatomically in the Lewinnek safe zone fell outside the safe zone during more than half of the gait cycle and static standing.Conclusion: The current study revealed that an anatomically well-placed acetabular cup does not guarantee a well-functional orientation during daily activities. The in vivo mechanical performance and loading conditions of the THA component during other weight-bearing activities should be investigated in further studies.

scholarly journals Modular dual-mobility cups using ceramic liners: an original solution for selected indications?

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 59-65
Author(s):  
Rocco D’Apolito ◽  
Guido Bandettini ◽  
Filippo Maria Piana Jacquot ◽  
Luigi Zagra
Keyword(s):  
High Risk ◽  
Consecutive Series ◽  
Cobalt Chromium ◽  
Original Solution ◽  
Dual Mobility ◽  
Number Of Patients ◽  
Revision Tha ◽  
Ceramic Liner ◽  
Dual Mobility Cups ◽  
The Mean

Background: Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently “off-label” use. Patients and methods: This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. Results: 5 patients received the ceramic liner in the study period (2014–2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63–82) years, the mean follow-up was 36 (12–72) months. No dislocation occurred, and no adverse events related to the implant were recorded. Conclusions: The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.

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