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

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.

Hip Arthroplasty up to the Age of 30 and Considerations in Relation to Subsequent Revision

We reviewed a series of 17 hip arthroplasties in 16 patients performed when the patients were 30 years old or younger who presented to us for consideration of revision. The mean age was 23.1 years (14 to 30) at the initial arthroplasty. At the time of the original procedure there were 4 sequelae of septic arthritis, 7 old traumatic hip injures, 3 cases of developmental dysplasia (DDH), 1 case of rheumatoid arthritis (RA), 1 steroid-induced avascular necrosis, and 1 old slipped upper femoral epiphysis (SUFE) The implants inculded 11 total hip arthroplasties (THA), 3 double cup arthroplasties, 1 bipolar arthroplasty,1 monopolar arthroplasty and 1 cup arthroplasty. The cause for revision lay on the acetabular side in 16 cases and on the femoral side in 6 cases (some had failure on both sides of the joint). There was one revision for recurrent dislocation. The patients had undergone a mean of 1.1 procedures (range 0–3) before the primary arthroplasty. There was a mean interval of 10.6 years (2–33) between the arthroplasty and the revision and the patients had a mean of 1.9 further revision procedures (0 to 4). Complications of revision surgery inculded 1 case of sepsis, 2 recurrent dislocations and 8 re-revisions. Postel and Merle d'Aubigne (PMA) score increased from 10.1 to 14.6 at an mean follow-up of 5.4 years (1 to 20). The typical patient was male (11/17) having had the first arthroplasty at age 23 for trauma sequelae (7/17), a revision at 34 (acetabular failure (16/17). At age 46.4, and after 1.9 secondary procedures hip scores were not exceptional. Such generally disappointing results arose from errors in implant selection or technical mistakes. Careful surgery is critical, and the way of life of the patient may need to be modified.