Treatment of recurrent THR dislocation using of a cementless dual-mobility cup: A 59 cases series with a mean 8 years’ follow-up - 28/01/11

Doi : 10.1016/j.otsr.2010.08.003

F. Leiber-Wackenheim ^a,^b,^⁎ , B. Brunschweiler ^a, M. Ehlinger ^b, A. Gabrion ^a, P. Mertl ^a
^a Orthopedics Department, Amiens University Hospital, place Victor-Pauchet, 80054 Amiens, France
^b Orthopedics-Traumatology Department, Hautepierre University Hospital, 1, avenue Molière, 67098 Strasbourg, France

Corresponding author. Tel.: +33 3 88 12 77 19; fax: +33 3 88 12 77 13.

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Summary

Introduction

Instability is one of the most feared complications following total hip replacement (THR). In France, dual-mobility cups are widely used in acetabular revision for instability; few studies, however, have focused on this type of implant.

Hypothesis

The gain in stability provided by the dual-mobility implant allows the risk of dislocation to decrease by the sole revision of the acetabular component in case of recurrent instability.

Objectives

This hypothesis was tested over medium-term follow-up of a series of cementless dual-mobility cups implanted during isolated acetabular revision for recurrent dislocation.

Patients and methods

A series of THR revision for instability was analyzed retrospectively. Inclusion criteria were: recurrent THR dislocation treated by cementless dual-mobility cup, between 1995 and 2001. Radiological analysis used Imagika™ software. Fifty-nine patients were included; nine died before radioclinical follow-up could be performed; none of the survivors were lost to follow-up. Mean follow-up was 8 years (range, 6–11 years).

Results

There was one early dislocation without recurrence; the dislocation rate was 1.7%. At follow-up, mean PMA score was 16.5 (12–18) and mean Harris score 86.7 (49–99). Radiologically, there was no loosening or migration, but 19% of X-ray views showed less than 1mm wide peri-acetabular radiolucency. With dislocation as censoring criterion, 8-year survivorship was 98% (95% CI: 95–100%).

Discussion

The dislocation rate (1.7%) and clinical results were better than in most series of revision by constrained cup for recurrent dislocation. The high rate of peri-acetabular radiolucency would seem to relate to the external coating of the cup: aluminum oxide in the Novae-1 implant and aluminum oxide/hydroxyapatite in the Novae-E.

Conclusion

The use of dual-mobility cups to treat THR instability gave satisfactory results. We recommend dual-mobility cups with hydroxyapatite surface treatment over a porous metallic substrate, rather than with an aluminum oxide or an aluminum oxide/hydroxyapatite bilayer coating.