The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation

The Clinical Orthopaedic Research Centre, Department of Reconstructive and Orthopaedic Surgery, Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, Université René Descartes, Hôpital Cochin (AP-HP), 75014, Paris, France.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 12/2010; 468(12):3248-54. DOI: 10.1007/s11999-010-1404-7
Source: PubMed


The treatment of recurrent dislocation after total hip arthroplasty remains challenging. Dual mobility sockets have been associated with a low rate of dislocation but it is not known whether they are useful for treating recurrent dislocation.
We therefore asked whether a cemented dual mobility socket would (1) restore hip stability following recurrent dislocation; (2) provide a pain-free and mobile hip; and (3) show durable radiographic fixation.
We retrospectively reviewed 51 patients treated with a cemented dual mobility socket for recurrent dislocation after total hip arthroplasty between August 2002 and June 2005. The mean age at the time of the index procedure of was 71.3 years. Of the 51 patients, 47 have had complete clinical and radiographic evaluation data at a mean followup of 51.4 months (range, 25-76.3 months).
The cemented dual mobility socket restored complete stability of the hip in 45 of the 47 patients (96%). The mean Merle d'Aubigné hip score was 16 ± 2 at the latest followup. Radiographic analysis revealed no or radiolucent lines less than 1 mm thick located in a single acetabular zone in 43 of 47 hips (91.5%). The cumulative survival rate of the acetabular component at 72 months using revision for dislocation and/or mechanical failure as the end point was 96% ± 4% (95% confidence interval, 90%-100%).
A cemented dual mobility socket was able to restore hip stability in 96% of recurrent dislocating hips. However, longer-term followup is needed to ensure that dislocation and loosening rates will not increase.

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Available from: Moussa Hamadouche, Apr 29, 2014
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    • "On the other hand, the dual mobility device (tripolar unconstrained acetabular cup) aims to not only reduce dislocation risk but also lower loosening by increasing the functional diameter of the head and thus reducing impingement, wear, and dissociation. Since their development (Novae-1 Ⓡ , Serf, Décines, France) in the 1970s, they have provided a reliable solution in the revision setting for older low-demand patients as supported by midterm data with rates of dislocation at 1.1% and loosening at 2.2%, although there is a lack of significant evidence to support their use in the younger high demand patient31323334. The aim is to allow a greater range of motion through the use of a large diameter head before it impinges against the polyethylene liner hence preventing intraprosthetic dislocation[34]. "
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    ABSTRACT: Primary total hip arthroplasty is a successful procedure, although complications such as dislocation can occur. In certain patient populations if this is recurrent, it can be difficult to manage effectively. We present a retrospective analysis of our experience of using a capture/captive cup over an 8-year period for frail elderly patients who presented with recurrent hip dislocations. Our findings show no redislocations in our cohort and a survival analysis demonstrates just less than half surviving at 2 years after surgery. Furthermore, Harris Hip Scores were generally calculated to be good. A constrained acetabular component provides durable protection against additional dislocations without substantial deleterious effects on component fixation. Such components should be considered especially in a group of patients with comorbidities or those who are fragile, elderly, and low-demand in nature.
    Full-text · Article · Jan 2016
    • "Several studies have reported good results and low rate of dislocation in revision THA, including complex scenarios such as recurrent dislocation [10] [11] [52] [54] [57] [62] [63] [67] [70], substantial bone loss [53], with cage constructs [60] [64], and for failure of metal-on-metal devices secondary to ARMD [65] [68]. Mertl et al. [63] recently reported 180 patients (180 hips) treated with dual mobility for recurrent dislocation, and observed 96.2% survival and only a 5% recurrence of dislocation at a mean follow-up of 7.7 years. "
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    ABSTRACT: Dual mobility liners represent an alternative to large heads to prevent dislocation. We used dual mobility in primary total hip arthroplasty in 2 patients (3 hips) with cerebral palsy; there were no dislocations or revisions at a mean follow-up of 2.3 years. In 22 patients (22 hips) revised to dual mobility, the most prevalent indication was adverse reaction to metal debris. There were 3 re-revisions at 1.8 years: 1 recurrent dislocation precipitated by traumatic injury, 1 deep infection and 1 unexplained pain. For abductor deficiency, a constrained liner may be indicated.
    No preview · Article · Apr 2015 · Seminars in Arthroplasty
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    • "The rate of 10.4% is therefore lower than that reported in the main registers. One hypothesis to explain this difference would be the more frequent use of dual mobility cups in France to reduce the risk of dislocation during primary arthroplasties in particular in high-dislocation-risk patients [24]. Our results suggest that the use of the dual mobility cup does in fact reduce the rate of revision for ''classic'' dislocation (5.6%) compared to the use of a standard flat liner (9.1%), but there is no difference (8.8%) if intraprosthetic dislocations, which specifically occur in dual mobility cups, are taken into account, tending to invalidate this hypothesis . "
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    ABSTRACT: La survenue d’une instabilité après prothèse totale de hanche (PTH) peut conduire à une reprise chirurgicale et cette cause de révision est l’une des plus fréquentes dans les registres nationaux. Les objectifs de cette étude étaient de déterminer les caractéristiques des PTH révisées pour instabilité et d’identifier le profil type de la hanche reprise pour instabilité.
    Full-text · Article · Sep 2013 · Revue de Chirurgie Orthopédique et Traumatologique
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