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Kaddick C, Schmidt C, Grupp TM, Steffens J. Impingement testing of total hip replacements according to ASTM F2582 - Implant wear, resistance to damage and acceptance criteria. J Mech Behav Biomed Mater 2024; 150:106270. [PMID: 38056402 DOI: 10.1016/j.jmbbm.2023.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES The aim of this study was to determine the resistance to impingement damage of three different artificially aged UHMWPE materials used for total hip joint replacement. The results obtained can be used as a basis for an acceptance criterion for testing according to ASTM F2582-20. METHODS Three different polyethylene liner materials, standard polyethylene (UHMWPE), moderately crosslinked (XLPE) and vitamin E stabilized crosslinked (XLPE-VE) polyethylene of the same design and manufacturer were tested up to one million impingement cycles according to ASTM F2582-20. The liners were artificially oxygen aged for two and three weeks according to ASTM F2003-02. The wear volumes of the liner, acetabular shells, and hip endoprosthesis stems were determined. Each of the six impingement test groups consisted of three samples. For each test group, a reference group was subjected to the same conditioning and loading conditions but without impingement between the hip stem and the liner. The force needed to disassemble the liner from the acetabular shell (push-out force) was determined according to ASTM F1820-22 for the test and the reference groups. RESULTS XLPE and XLPE-VE polyethylene groups showed less impingement wear when compared to the standard UHMWPE material. Similarly, the protective function of the liner against direct metal-on-metal contact was greater, resulting in less wear on the acetabular shell and the stem neck. The three weeks aged standard UHMWPE group showed early onset of fatigue delamination wear. The push-out values remained unchanged for all XLPE liners and the 3-week aged XLPE-VE liners. The aged UHMWPE liners showed low push-out strength due to component shrinkage caused by aging in combination with the tapered fixation used for this specific design. SIGNIFICANCE The largest polyethylene wear volume measured of XLPE and XLPE-VE polyethylene aged for two and three weeks was 15.05 mm³ (SD 0.56 mm³). The corresponding metal wear volume was 1.23 mm³ (SD 0.19 mm³) for the acetabular cup and 1.33 mm³ (SD 0.20 mm³) for the stem neck. Those values can support the definition of an acceptance criteria for impingement testing. The results of the push-out test required by ASTM F2582-20 should be evaluated with respect to geometry changes caused by aging. The protective effect of the polyethylene liner against metal-on-metal contact should be considered in the implant design phase in order to avoid implant failure due to metal debris.
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Affiliation(s)
- C Kaddick
- Endolab Mechanical Engineering, Riedering, Germany.
| | - C Schmidt
- Endolab Mechanical Engineering, Riedering, Germany
| | - T M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich, Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | - J Steffens
- Endolab Mechanical Engineering, Riedering, Germany
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2
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van Dooren B, Peters RM, Visser D, van Steenbergen LN, Bos PK, Zijlstra WP. Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup. Arthroplast Today 2024; 25:101281. [PMID: 38292143 PMCID: PMC10826135 DOI: 10.1016/j.artd.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.
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Affiliation(s)
- Bart van Dooren
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Orthopedic surgery, Martini Hospital, Groningen, The Netherlands
| | - David Visser
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - P Koen Bos
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Tigani D, Banci L, Stallone S, Melucci G, Pieratelli G, Castiello E. Evolution and New Generation of Dual Mobility Cups. Orthopedics 2023; 46:e273-e280. [PMID: 37561099 DOI: 10.3928/01477447-20230804-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Although total hip arthroplasty (THA) is considered a successful procedure, hip dislocation remains the main cause of early failure. Dual mobility cups (DMCs) have been shown to significantly reduce the dislocation rate in both primary and revision THAs. During the past several decades, DMCs have evolved in design and fixation interface. There have been three generations of DMCs. This article addresses the rationale for a new cementless highly porous titanium DMC to improve component fixation and implant biocompatibility. [Orthopedics. 2023;46(5):e273-e280.].
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Wakeling CP, Wilson MJ, Whitehouse SL, Howell JR. Mixed manufacturer dual mobility bearing and the Exeter V40 Stem: is it safe? Short-term results in primary and revision hip replacement. Acta Orthop Belg 2023; 89:340-347. [PMID: 37924552 DOI: 10.52628/89.2.6812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
The aim is to review clinical and radiological outcomes for all cases of primary and revision THA, combining a cemented stem (Exeter V40) with a dual mobility component from a different manufacturer (SERF Novae), to evaluate whether concerns regarding mixing components from different manufacturers are justified. We identified 72 hip replacements performed between May 2010 and December 2015 using the SERF Novae dual mobility cup with an Exeter V40 stem, the majority of which were cemented (90%) and revisions (58%). Patients were evaluated clinically and radiologically at a minimum of two years. There were five (6.9%) dislocations; three (4.2%) requiring revision - one of which was an intra-prosthetic disarticulation and two infections. No cases were lost to follow-up and 49 surviving cases were reviewed at a mean of 4.0 (range 1.8-8.1) years following surgery. Pain and functional outcome scores all improved. There were no radiological failures and no revisions for aseptic loosening of stem or cup. The combination of Exeter cemented stem with a dual mobility bearing from a different manufacturer results in acceptable short-term outcomes in terms of hip stability, revision rates and patient-reported measures.
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Fessy MH, Fessy A, Viste A. Analysis of an explanted dual mobility cup after 21 years, parabolic wear pattern: A case report. SICOT J 2023; 9:3. [PMID: 36661475 PMCID: PMC9878998 DOI: 10.1051/sicotj/2022052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/26/2022] [Indexed: 01/21/2023] Open
Abstract
CASE A dual mobility cup was implanted in 1983 in a 43-year woman. After 31 years of normal function, we analysed the explanted materials with modern techniques. CONCLUSION Volumetric wears of the small and large articulations of the dual-mobility construct were similar. For the first time, we demonstrated that the dual-mobility liner underwent parabolic (not linear) wear during the period of implantation.
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Affiliation(s)
- Michel-Henri Fessy
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique et Traumatologique 165 Chemin du Grand Revoyet 69495 Pierre Bénite Cedex France,Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMRT_9406 Lyon France
| | | | - Anthony Viste
- Hospices Civils de Lyon, Hôpital Lyon Sud, Chirurgie Orthopédique et Traumatologique 165 Chemin du Grand Revoyet 69495 Pierre Bénite Cedex France,Univ de Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, LBMC UMRT_9406 Lyon France,Corresponding author:
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Wegrzyn J, Longaray J, Baez R, Herrera L. Which femoral neck for a dual mobility cup? A biomechanical evaluation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1783-1793. [PMID: 35570206 PMCID: PMC9349148 DOI: 10.1007/s00264-022-05415-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
This study aimed to evaluate polyethylene (PE) damage and wear lesions to the chamfer of mobile components under mobile and fixed femoral neck impingement at the third articulation, and to determine which femoral neck characteristics should be considered with a dual mobility cup to limit those lesions.
Methods
Two femoral neck geometries (cylindrical and quadrangular) with two surface finishing roughness (rough and polished), and two head-to-neck ratios (28- and 22.2-mm diameter femoral heads) were evaluated in a hip simulator testing. For each characteristic, six femoral necks were tested with six dual mobility cups under fixed and mobile femoral neck impingement conditions. Chamfer PE damage and volumetric wear were evaluated and compared for each femoral neck characteristic and impingement condition.
Results
Under mobile impingement condition, femoral neck characteristics did not significantly affect PE damage and wear lesions to the chamfer (p = 0.283 to 0.810). However, under fixed impingement condition, significantly higher PE damage and wear lesions to the chamfer were produced by the quadrangular geometry compared to the cylindrical geometry (p = 0.004 to 0.025). In addition, with the quadrangular geometry, rough surface finishing was demonstrated to increase volumetric wear of the chamfer (p = 0.009). No significant influence of head-to-neck ratio was observed on PE damage and wear lesions to the chamfer (p = 0.244 to 0.714).
Discussion
This biomechanical study emphasized that femoral neck characteristics are critical with dual mobility cup and tend to favor a cylindrical geometry particularly whether fixed impingement at the third articulation occurs.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Avenue Pierre Decker, 4, CH - 1011, Lausanne, Switzerland.
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Dalli D, Buhagiar J, Mollicone P, Schembri Wismayer P. A novel hip joint prosthesis with uni-directional articulations for reduced wear. J Mech Behav Biomed Mater 2022; 127:105072. [PMID: 35033983 DOI: 10.1016/j.jmbbm.2021.105072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
A novel polymer-on-metal hip joint prosthesis design that makes use of uni-directional articulations was developed and tested in this work. The new implant was tested using two polymer variants, virgin ultra-high molecular weight polyethylene (UHMWPE), and Vitamin E-infused highly crosslinked polyethylene (VEHXPE). The degrees of freedom of the ball-and-socket are reproduced by three cylindrical orthogonally-aligned articulations. This unconventional design leverages on the molecular orientation hardening mechanisms of the polyethylene and increased contact area to minimize wear. An experimental hip joint simulator was used to compare the gravimetric wear of the conventional ball-on-socket and the new implant. The new prosthesis including UHMWPE components produced a 78% reduction in wear, whereas the new prosthesis with VEHXPE components produced a 100% reduction in wear, as no measurable wear was detected. Machining marks on the acetabular cups of the new prosthesis were retained for both polyethylene variants, further demonstrating the low levels of wear exhibited by the new implants. Both polyethylene materials produced particles in the range of 0.1-1.0 μm, which are the most biologically active. Nonetheless, the extremely low wear rates are likely to induce minimal osteolysis effects. Furthermore, the novel design also offers an increase of more than 24% in the range of motion in flexion/extension when compared to a dual-mobility hip implant. A prototype of the prosthesis was implanted into a Thiel-embalmed human cadaver during a mock-surgery, which demonstrated high resistance to dislocation and the possibility of performing a figure of four position.
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Affiliation(s)
- Donald Dalli
- Department of Metallurgy and Materials Engineering, Faculty of Engineering, University of Malta, Msida, MSD 2080, Malta
| | - Joseph Buhagiar
- Department of Metallurgy and Materials Engineering, Faculty of Engineering, University of Malta, Msida, MSD 2080, Malta.
| | - Pierluigi Mollicone
- Department of Mechanical Engineering, Faculty of Engineering, University of Malta, Msida, MSD 2080, Malta
| | - Pierre Schembri Wismayer
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta
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Rodríguez Pérez D, Agulló Ferre JL, Del Carmen Rodríguez M, Tramunt Monsonet C. Late Breakage of a Dual-Mobility Polyethylene Insert in a Revision Total Hip Arthroplasty: An Unusual Failure Mode. Arthroplast Today 2021; 12:7-11. [PMID: 34746346 PMCID: PMC8551416 DOI: 10.1016/j.artd.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022] Open
Abstract
The use of dual-mobility cups has gained popularity in recent years. Thus, surgeons can expect an increase in known and new causes of failure. We report a previously undescribed form of a late intraprosthetic dislocation consisting of a complete breakage of a polyethylene mobile bearing that suffered a dislocation 3 months after its implantation. Two years later, he began feeling anterior groin pain and suffered gait changes. Computed tomography scan revealed an eccentric alignment of the mobile polyethylene bearing suggestive of poly wear. During the revision surgery, the polyethylene was found to be split in 2. Possible causes of this complication are proposed. Our case shows a previously unreported implant-specific complication, so surgeons can identify it.
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9
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Lygrisse KA, Matzko C, Shah RP, Macaulay W, Cooper JH, Schwarzkopf R, Hepinstall MS. Femoral Neck Notching in Dual Mobility Implants: Is This a Reason for Concern? J Arthroplasty 2021; 36:2843-2849. [PMID: 33875287 DOI: 10.1016/j.arth.2021.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dual mobility (DM) total hip arthroplasty (THA) implants have been advocated for patients at risk for impingement due to abnormal spinopelvic mobility. Impingement against cobalt-chromium acetabular bearings, however, can result in notching of titanium femoral stems. This study investigated the incidence of femoral stem notching associated with DM implants and sought to identify risk factors. METHODS A multicenter retrospective study reviewed 256 modular and 32 monoblock DM components with minimum 1-year clinical and radiographic follow-up, including 112 revisions, 4 conversion THAs, and 172 primary THAs. Radiographs were inspected for evidence of femoral notching and to calculate acetabular inclination and anteversion. Revisions and dislocations were recorded. RESULTS Ten cases of femoral notching were discovered (3.5%), all associated with modular cylindrospheric cobalt-chromium DM implants (P = .049). Notches were first observed radiographically at mean 1.3 years after surgery (range 0.5-2.7 years). Notch location was anterior (20%), superior (60%), or posterior (20%) on the prosthetic femoral neck. Notch depth ranged from 1.7% to 20% of the prosthetic neck diameter. Eight cases with notching had lumbar pathology that can affect spinopelvic mobility. None of these notches resulted in stem fracture, at mean 2.7-year follow-up (range 1-7.6 years). There were no dislocations or revisions in patients with notching. CONCLUSION Femoral notching was identified in 3.5% of DM cases, slightly surpassing the dislocation rate in a cohort selected for risk of impingement and instability. Although these cases of notching have not resulted in catastrophic failures thus far, further study of clinical sequelae is warranted. Component position, spinopelvic mobility, and implant design may influence risk.
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Affiliation(s)
| | - Chelsea Matzko
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia Univeristy Irving Medical Center, New York, NY
| | - William Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - John H Cooper
- Department of Orthopedic Surgery, Columbia Univeristy Irving Medical Center, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY
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Chouteau J, Rollier JC, Bonnin MP, Saffarini M, Nover L, Chatelet JC, Jacquot L. Absence of instabilities and intra-prosthetic dislocations at 7 to 11 years following THA using a fourth-generation cementless dual mobility acetabular cup. J Exp Orthop 2020; 7:51. [PMID: 32661747 PMCID: PMC7359208 DOI: 10.1186/s40634-020-00265-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Dual-mobility (DM) cups are increasingly used in total hip arthroplasty (THA) but there lacks literature on their long-term results. We aimed to investigate outcomes of a fourth-generation cementless DM acetabular cup at 7-11 years. METHODS We retrospectively evaluated 240 consecutive hips that received cementless THA using the same dual mobility cup (Novae Sunfit TH) and femoral stem (Corail). Patients were recalled at ≥7 years to collect Oxford hip scores (OHS), Harris hip scores (HHS), and inspect for radiolucent lines and granulomas. Multi-variable analyses were performed to determine whether HHS or OHS were associated with pre- or intra-operative variables. RESULTS At 8.4 ± 0.8 years (range, 7-11), 6 hips were revised (2.5%), 54 deceased (22.5%), and 14 could not be reached (5.8%). Four revisions (2 cup+stem, 2 liners only) were due to sepsis (1.7%), one (cup and stem) for trauma (0.4%), and one (stem) due to aseptic loosening (0.4%). For the remaining 166 hips, HHS was 83.6 ± 13.2 and OHS was 20.3 ± 6.7. Multi-variable analysis confirmed that HHS (β = - 0.38; p = 0.039) and OHS (β = 0.36; p < 0.001) worsened with age, and that OHS was worse for Charnley C patients (β = 3.17; p = 0.009). Neither granulomas nor radiolucenies were observed around any cups, but radiolucenies were seen around 25 stems (20.3%). CONCLUSIONS This fourth-generation DM cup demonstrated satisfactory outcomes at 7-11 years, with no instabilities or cup revisions due to aseptic loosening. Better OHS was observed for younger patients and those presenting higher Charnley grade. LEVEL OF EVIDENCE Level IV, retrospective case study.
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Affiliation(s)
- Julien Chouteau
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
| | - Michel P Bonnin
- Artro Group Institute, Lyon, France.,Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | | | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France.,Centre de Chirurgie Orthopédique du Beaujolais, Ramsay Santé, Arnas, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France.,Clinique d'Argonay, Ramsay Santé, Annecy, France
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Neri T, Boyer B, Batailler C, Klasan A, Lustig S, Philippot R, Farizon F. Dual mobility cups for total hip arthroplasty: tips and tricks. SICOT J 2020; 6:17. [PMID: 32553100 PMCID: PMC7301635 DOI: 10.1051/sicotj/2020018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022] Open
Abstract
Since its creation in 1974, the Dual Mobility Cup (DMC) has been gaining in popularity, especially in the past decade. This intensive use could lead to inappropriate use and consequently to an increased complication rate. Compliance with conceptual requirements and surgical techniques will prevent the occurrence of complications that can be wrongly attributed to implants. In this context, we feel that it is essential to share our tips and tricks as well as an overview and an explanation of common errors, based on more than 45 years of clinical and research experience. From basic principles, including indications, implant choice and implant compatibility, to surgical tips, in this article orthopedic surgeons will find a practical overview of DMC in order to use it safely and with confidence.
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Affiliation(s)
- Thomas Neri
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon - University Jean Monnet Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Bertrand Boyer
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - INSERM U1059 SAINBIOSE, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Antonio Klasan
- North Shore Hospital, 124 Shakespeare Road, Takapuna, 0620 Auckland, New Zealand
| | - Sebastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Remi Philippot
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - EA 7424 - Inter-University Laboratory of Human Movement Science, University Lyon - University Jean Monnet Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France
| | - Frederic Farizon
- Department of Orthopaedic Surgery, University Hospital Centre of Saint-Étienne, avenue Albert Raimond, 42000 Saint-Étienne, France - INSERM U1059 SAINBIOSE, avenue Albert Raimond, 42000 Saint-Étienne, France
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12
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Reply to Letter to the Editor: Is Isolated Mobile Component Exchange an Option in the Management of Intraprosthetic Dislocation of a Dual Mobility Cup? Clin Orthop Relat Res 2020; 478:1385-1388. [PMID: 32332247 PMCID: PMC7319395 DOI: 10.1097/corr.0000000000001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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Is Isolated Mobile Component Exchange an Option in the Management of Intraprosthetic Dislocation of a Dual Mobility Cup? Clin Orthop Relat Res 2020; 478:279-287. [PMID: 31794492 PMCID: PMC7438138 DOI: 10.1097/corr.0000000000001055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraprosthetic dislocation is a specific complication of dual mobility cups, although it occurs less frequently with the latest generations of implants. Intraprosthetic dislocation is related to long-term polyethylene wear of the mobile component chamfer and retentive area, leading to a snap-out of the femoral head. With the increased use of dual mobility cups, even in younger and active patients, the management of intraprosthetic dislocation should be defined according to its type. However, no previous studies, except for case reports, have described the strategy to manage long-term wear-related intraprosthetic dislocation, particularly when a dual mobility cup is not loose. QUESTIONS/PURPOSES This study aimed to (1) determine the prevalence of intraprosthetic dislocation in this patient population and the macroscopic findings at the time of surgical revision and (2) evaluate whether isolated mobile component exchange could be an option to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. METHODS From January 1991 to December 2009, a continuous series of 5274 THAs with dual mobility cups (4546 patients; 2773 women; mean [range] age 58 years [22-87]; bilateral THA = 728) were prospectively enrolled in our institutional total joint registry. A cementless, hemispherical dual mobility cup was systematically implanted, regardless of the patient's age or indication for THA. At the latest follow-up examination, the registry was queried to isolate each occurrence of intraprosthetic dislocation, which was retrospectively analyzed regarding the patient's demographics, indication for THA, radiographs, intraoperative findings (polyethylene wear and lesion patterns on the mobile component, periarticular metallosis, and implant damage because of intraprosthetic impingement of the femoral neck), management of intraprosthetic dislocation (isolated exchange of the mobile component or revision of the dual mobility cup), and outcome. RESULTS At a mean (range) follow-up duration of 14 years (3-26), 3% of intraprosthetic dislocations (169 of 5274) were reported, with a mean (range) time from THA of 18 years (13-22). Intraprosthetic dislocation occurred predominantly in younger men (mean [range] age at THA, 42 years [22-64] versus 61 years [46-87]; p < 0.001, and sex ratio (male to female, 1:32 [96 male and 73 female] versus 0.62 [1677 male and 2700 female]; p < 0.001) in patients with intraprosthetic dislocation and those without, respectively, but was not influenced by the indication for THA (105 patients with intraprosthetic dislocation who underwent THA for primary hip osteoarthritis and 64 with other diagnoses versus 3146 patients without who underwent THA for primary hip osteoarthritis and 1959 for other diagnoses (p = 0.9)). In all patients with intraprosthetic dislocation, a macroscopic analysis of the explanted mobile component revealed circumferential polyethylene wear and damage to the chamfer and retentive area, with subsequent loss of retaining power for the femoral head. Nine percent of intraprosthetic dislocations (16 of 169 patients with intraprosthetic dislocations) were associated with aseptic loosening of the dual mobility cup and were managed with acetabular revision without recurrence at a mean (range) follow-up duration of 7.5 years (5-11). Ninety-one percent of intraprosthetic dislocations (153 of 169) were pure, related to wear of the mobile component chamfer and retentive area without aseptic loosening of the dual mobility cup, and managed with isolated mobile component exchange. Intraprosthetic dislocation recurred in 6% (nine of 153) at a mean (range) follow-up interval of 3 years (2-4.5). Additionally, severe premature polyethylene wear of the mobile component with loosening of the dual mobility cup occurred in 12% of patients (19 of 153) at a mean (range) follow-up duration of 1.5 years (0.5-3). CONCLUSIONS A failure rate of 18% (28 of 153 patients undergoing isolated mobile component exchange) was reported within 5 years after isolated mobile component exchange to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell. The two modes of failure were early recurrence of intraprosthetic dislocation or severe premature metallosis-related polyethylene wear of the mobile component with loosening of the dual mobility cup. Acetabular revision with synovectomy should remain the standard procedure to manage intraprosthetic dislocation, particularly if periarticular metallosis is present. The exception is intraprosthetic dislocation occurring in elderly or frail patients, for whom a conventional acetabular revision procedure would be associated with an unjustified surgical or anesthetic risk. LEVEL OF EVIDENCE Level II, prognostic study.
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Reina N, Pareek A, Krych AJ, Pagnano MW, Berry DJ, Abdel MP. Dual-Mobility Constructs in Primary and Revision Total Hip Arthroplasty: A Systematic Review of Comparative Studies. J Arthroplasty 2019; 34:594-603. [PMID: 30554926 DOI: 10.1016/j.arth.2018.11.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/05/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Utilization of dual-mobility constructs in total hip arthroplasties (THA) has increased in the recent years. Benefits and risks of these implants in terms of reducing dislocations, long-term survivorship, and associated complications are uncertain when compared to non-dual-mobility articulations. METHODS A systematic review of prospective and retrospective studies that compared dual-mobility constructs with controls for primary or revision THAs between 1986 and 2018 was performed. All articles in both English and French were reviewed. RESULTS Five studies with primary THAs and 6 with revision THAs were analyzed. For primary THAs, the overall rate of dislocation was 0.9% in the dual-mobility group compared to 6.8% in the control group (P < .001) at a mean follow-up of 7.6 years. The odds ratios for the control group to the dual-mobility group were 4.06 (P < .001) for dislocation, 1.18 (P = .87) for revision, 2.97 (P = .04) for revision due to dislocation, 1.67 (P = .57) for infection, 0.6 (P = .53) for fracture, and 1.21 (P = .81) for aseptic loosening. Similarly, for revision THAs, the overall dislocation rates were 2.2% compared to 7.1% (P < .001) at a mean follow-up of 4.1 years. The odds ratios for the control group to the dual-mobility group were 3.59 (P < .001) for dislocation, 2.46 (P < .001) for re-revision, 4.88 (P = .007) for re-revision due to dislocation, 1.51 (P = .32) for infection, 1.18 (P = .81) for fracture, and 2.71 (P = .003) for aseptic loosening. CONCLUSION This systematic review of comparative studies supports the efficacy of dual-mobility constructs to minimize dislocation after both primary and revision THAs in addition to excellent mid-term survivorship compared to control constructs. However, further evidence is needed to evaluate the long-term risks and benefits of dual-mobility constructs in the primary and revision THA setting when compared to contemporary conventional implants. LEVEL OF EVIDENCE III, therapeutic.
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Affiliation(s)
- Nicolas Reina
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Neri T, Philippot R, Klasan A, Putnis S, Leie M, Boyer B, Farizon F. Dual mobility acetabular cups for total hip arthroplasty: advantages and drawbacks. Expert Rev Med Devices 2018; 15:835-845. [PMID: 30345834 DOI: 10.1080/17434440.2018.1538781] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The dual mobility cup (DMC) concept was proposed by Professor Gilles Bousquet in 1974. Its' aims were to prevent postoperative dislocation, restore the physiological range of motion of the hip, and reduce the stresses at the interface. Since it was created, this design has been modified multiple times to reduce the complication rate, improve implant survival, and expand the indications. AREAS COVERED The objective of this review is to discuss the advantages and disadvantages of this implant based on its 40-year history and also to propose a range of indications based on published results. This will provide surgeons with a complete overview of DMC. EXPERT COMMENTARY Published studies on DMC confirm the low dislocation rate. Improvements made to DMC overtime have greatly reduced the complications related to wear, such as aseptic loosening and intraprosthetic dislocation (IPD). According to the literature, the indications have expanded and are no longer limited to revision surgery only. Long-term studies are needed before we can draw formal conclusions and consolidate these promising results.
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Affiliation(s)
- Thomas Neri
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France.,c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Remi Philippot
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Antonio Klasan
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Sven Putnis
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Murilo Leie
- c Sydney Orthopaedic Research Institute , Sydney , Australia
| | - Bertrand Boyer
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
| | - Frederic Farizon
- a Department of Orthopaedic Surgery , University Hospital Centre of Saint-Etienne , Saint Etienne , France.,b EA 7424, Inter-university Laboratory of Human Movement Science , University Lyon, University Jean Monnet , Saint Etienne , France
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Mavrogenis AF, Quaile A, Pećina M, Scarlat MM. Citations, non-citations and visibility of International Orthopaedics in 2017. INTERNATIONAL ORTHOPAEDICS 2018; 42:2499-2505. [PMID: 30298386 DOI: 10.1007/s00264-018-4198-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marko Pećina
- Department of Orthopaedics, School of Medicine, University of Zagreb, Zagreb, Croatia
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