The Lefèvre retentive cup compared with the dual mobility cup in total hip arthroplasty revision for dislocation

A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants

BACKGROUND

The incidence of dislocation after revision total hip arthroplasty (rTHA) is reported to be up to 25% and remains a common source of failure. Constrained acetabular components and dual mobility implants are two implant classes being utilized to alleviate this burden in patients who have recurrent instability or major intraoperative instability. This meta-analysis evaluated the incidence and temporal trends of dislocation after implantation with constrained acetabular components and dual mobility implants in rTHA.

METHODS

Longitudinal studies reporting dislocation after the use of constrained acetabular components or dual mobility implants in rTHA were sought from Medline and Embase to October 2022. Secondary outcomes included re-revision surgery for dislocation and all causes. A total of 75 relevant citations were identified comprising 36 datasets of 3,784 constrained acetabular components and 47 datasets of 10,216 dual mobility implants.

RESULTS

For constrained acetabular components, the pooled incidence of dislocation was 9% (95% confidence interval: 7.2, 11.7) (range 0.0%-35.3%) over a weighted mean follow-up of 6 years, in contrast to 3% (95% confidence interval: 2.2, 4.4) (range 0.0%-21.4%) over 5 years for dual mobility implants. Re-revision rates for dislocation after using constrained acetabular components were around 9%, in contrast to 2% for dual mobility implants. Re-revision rates for all causes after using constrained acetabular components were around 19%, in contrast to 8% for dual mobility implants.

CONCLUSION

Dual mobility implants in the context of rTHA demonstrate lower incidences of dislocation (3% versus 9%), re-revision for dislocation (2% versus 9%), and rer-evision for any cause (8% versus 19%) in contrast to constrained acetabular components. This must be considered by surgeons when implanting such devices, often selected to treat instability.

Acetabular reconstruction after advanced acetabular metastasis resection: Modified Harrington technique with a Kerboull reinforcement device

The surgical treatment of acetabular bone metastases rests on total hip arthroplasty (THA). In the event of major bone defects, the reconstruction may prove challenging. Two complicating factors are the need to obtain a mechanically stable acetabulum and the unfeasibility of using an autograft to increase the bone stock. The technique described in 1981 by Harrington involves implanting steel rods to reinforce the pelvis before sealing the prosthetic cup. We have now been using this technique for several years, and based on our accumulated experience we introduced several substantial modifications. The most important among them is the use of a Kerboull acetabular reinforcement device (KARD) in addition to the iliac pins. This reinforcement of the acetabulum, which is widely used for THA, serves as the basis for guiding the reconstruction, while also facilitating the sealing of the prosthetic cup. Furthermore, we use centrally threaded rods to avoid secondary displacement. Finally, we routinely use a dual-mobility cemented cup to decrease the risk of dislocation. Here, we describe our acetabular reconstruction technique based on a modified Harrington technique, which is used for acetabular reconstruction in patients with advanced acetabular metastases managed at our French referral centre.

Long-term survival of the Lefèvre retentive cup: 12-year follow-up analysis of 466 consecutive cases

INTRODUCTION

The Lefèvre retentive cup is a salvage solution for total hip replacement at high risk of dislocation. Only a few studies have reported the medium or long-term survival; most often, only a small number of patients were included in these studies. This led us to conduct a retrospective analysis of a large population to determine: 1) the 10-year survival rate after primary or revision arthroplasty, 2) the complication rate.

HYPOTHESIS

The dislocation rate is<5% for revision arthroplasty and<2% for primary arthroplasty.

MATERIAL AND METHODS

This single-center retrospective study included 466 consecutive total hip replacements performed with the Lefèvre retentive cup with a 12-year theoretical minimum follow-up (1/1/1998 to 31/8/2006). There were 257 indications for primary arthroplasty and 209 for revision arthroplasty. The cohort had 316 women and the mean age at surgery was 72.9years (30.2-89.9). The mean follow-up was 10.2±5 years (0.1-19.3). A statistical analysis was done based on the Kaplan-Meier survival curves in two subsets of patients: primary and revision surgery.

RESULTS

At the final review, 264 patients had died because of reasons unrelated to the procedures (mean 7.8±4.7years after the procedure), 48 were lost to follow-up (mean 3.0±3.3years after the procedure), and 39 patients (8%) had undergone acetabular revision of which 12 were for infection (2.5%), 25 were for loosening (5.4%) (5 femoral loosening only) and 2 were for dislocation (0.4%). In all, there were 10/466 dislocations (2.1%) of which 5/257 (1.9%) were in the primary group and 5/209 (2.4%) were in the revision group: 2 had a cup exchange and 8 were reduced by closed procedures. The probability of survival free of mechanical complications at 10years was estimated at 94.8%±1.6% (95% CI: 91.6%-98.0%) for the primary group and 87.8%±2.7% (95% CI: 82.4%-93.2%) for the revision groups (p=0.0017). There were 39 re-operations in the overall cohort: 1/257 (0.4%) for dislocation, 7/257 (2.7%) for aseptic loosening and 3/257 (1.2%) for infection in the primary group, while in the revision group, 1/209 (0.5%) was for dislocation, 18/209 (8.6%) for aseptic loosening and 9/209 (4.3%) for infection.

CONCLUSION

The Lefèvre retentive cup has good long-term survival with a low mechanical complication rate, both in primary and revision surgery. To us, this implant appears to be a reliable salvage procedure for total hip replacement in patients at high risk for dislocation.

LEVEL OF EVIDENCE

IV; retrospective study without control group.