What Is the Dislocation and Revision Rate of Dual-mobility Cups Used in Complex Revision THAs?
Journal
Clinical orthopaedics and related research
ISSN: 1528-1132
Titre abrégé: Clin Orthop Relat Res
Pays: United States
ID NLM: 0075674
Informations de publication
Date de publication:
01 02 2021
01 02 2021
Historique:
received:
06
03
2020
accepted:
03
08
2020
pubmed:
9
9
2020
medline:
6
8
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
Dual-mobility cups have been shown to reduce the dislocation risk after THA. Although dual-mobility cups can be a useful strategy to mitigate against recurrent dislocation after revision surgery, few clinical studies have focused on the results of complex revision THAs with extensive bone and soft-tissue loss or in patients who have undergone more than one previous surgical procedure. (1) What is the survival free from revision for dislocation of dual-mobility cups used in complex revision THAs? (2) What is the survival free from any dislocation? Between January 1, 2009 and December 31, 2013, 327 patients underwent a complex revision THA that included an acetabular revision, defined as preexisting massive bone loss in the acetabulum (at least Paprosky Type 2B) and/or proximal femur (at least Paprosky Type 3), substantial gluteal soft-tissue involvement, at least two previous surgical procedures or a one-stage septic revision, or history of dislocation. All 327 complex revision patients received a dual-mobility cup. Of those, 34% (111) were lost to follow-up before 5 years and were not known to have reached a study endpoint (revision for dislocation, and any dislocation) before then, leaving 216 patients for analysis. For patients with bilateral hip surgeries only the first operated hip was included for analysis. The median (range) follow-up duration was 69 months (60 to 110). The primary endpoint was dislocation or re-revision for dislocation. Fifty-six percent (120 of 216) of the patients were women and 44% (96 of 216) were men. The mean age of the patients was 69 ± 9 years. The patients underwent a median of four surgical procedures (1 to 4) before the index procedure (the revision evaluated in this study). A survival analysis was performed using the Kaplan-Meier method; any dislocation or revision for dislocation was determined as the endpoint. The dislocation-free survival rates were 96% (95% confidence interval 92 to 98) at 5 years and 82% (95% CI 72 to 89) at 9 years. The overall dislocation rate was 11% (24 of 216 patients) at the final follow-up interval. Survival free of revision for dislocation was 99% (95% CI 96 to 100) at 5 years and 85% (95% CI 75 to 92) at 9 years. Dual-mobility cups used in complex revision THA in this series had a higher rate of dislocation and revision than expected, based on earlier studies of dislocations of these components. Although we believe dual-mobility cups are still the first choice of implant if the patient has instability, these cups should be used cautiously if severe bone loss or soft-tissue involvement is present. Level III, therapeutic study.
Sections du résumé
BACKGROUND
Dual-mobility cups have been shown to reduce the dislocation risk after THA. Although dual-mobility cups can be a useful strategy to mitigate against recurrent dislocation after revision surgery, few clinical studies have focused on the results of complex revision THAs with extensive bone and soft-tissue loss or in patients who have undergone more than one previous surgical procedure.
QUESTIONS/PURPOSES
(1) What is the survival free from revision for dislocation of dual-mobility cups used in complex revision THAs? (2) What is the survival free from any dislocation?
METHODS
Between January 1, 2009 and December 31, 2013, 327 patients underwent a complex revision THA that included an acetabular revision, defined as preexisting massive bone loss in the acetabulum (at least Paprosky Type 2B) and/or proximal femur (at least Paprosky Type 3), substantial gluteal soft-tissue involvement, at least two previous surgical procedures or a one-stage septic revision, or history of dislocation. All 327 complex revision patients received a dual-mobility cup. Of those, 34% (111) were lost to follow-up before 5 years and were not known to have reached a study endpoint (revision for dislocation, and any dislocation) before then, leaving 216 patients for analysis. For patients with bilateral hip surgeries only the first operated hip was included for analysis. The median (range) follow-up duration was 69 months (60 to 110). The primary endpoint was dislocation or re-revision for dislocation. Fifty-six percent (120 of 216) of the patients were women and 44% (96 of 216) were men. The mean age of the patients was 69 ± 9 years. The patients underwent a median of four surgical procedures (1 to 4) before the index procedure (the revision evaluated in this study). A survival analysis was performed using the Kaplan-Meier method; any dislocation or revision for dislocation was determined as the endpoint.
RESULTS
The dislocation-free survival rates were 96% (95% confidence interval 92 to 98) at 5 years and 82% (95% CI 72 to 89) at 9 years. The overall dislocation rate was 11% (24 of 216 patients) at the final follow-up interval. Survival free of revision for dislocation was 99% (95% CI 96 to 100) at 5 years and 85% (95% CI 75 to 92) at 9 years.
CONCLUSIONS
Dual-mobility cups used in complex revision THA in this series had a higher rate of dislocation and revision than expected, based on earlier studies of dislocations of these components. Although we believe dual-mobility cups are still the first choice of implant if the patient has instability, these cups should be used cautiously if severe bone loss or soft-tissue involvement is present.
LEVEL OF EVIDENCE
Level III, therapeutic study.
Identifiants
pubmed: 32898046
pii: 00003086-202102000-00013
doi: 10.1097/CORR.0000000000001467
pmc: PMC7899605
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
280-285Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 by the Association of Bone and Joint Surgeons.
Déclaration de conflit d'intérêts
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.
Références
Bloemheuvel EM, Steenbergen LN va., Swierstra BA. Lower 5-year cup re-revision rate for dual mobility cups compared with unipolar cups: report of 15,922 cup revision cases in the Dutch Arthroplasty Register (2007–2016). Acta Orthop. 2019;90:338–341.
Blom AW, Rogers M, Taylor AH, Pattison G, Whitehouse S, Bannister GC. Dislocation following total hip replacement: The Avon Orthopaedic Centre experience. Ann R Coll Surg Engl. 2008;90:658–662.
Brüggemann A, Mallmin H, Hailer NP. Do dual-mobility cups cemented into porous tantalum shells reduce the risk of dislocation after revision surgery ? A retrospective cohort study on 184 patients. Acta Orthop. 2018;89:156–162.
Bryant D, Havey TC, Roberts R, Guyatt G. How many patients? How many limbs? Analysis of patients or limbs in the orthopaedic literature: A systematic review. J Bone Joint Surg Am. 2006;88:41–45.
Caton JH, Ferreira A. Dual-mobility cup : a new French revolution. Int Orthop. 2017;41:433–437.
Chughtai M, Mistry JB, Diedrich AM, Jauregui JJ, Elmallah RK, Bonutti PM, Harwin SF, Malkani AL, Kolisek FR, Mont MA. Low frequency of early complications with dual-mobility acetabular cups in cementless primary THA. Clin Orthop Relat Res. 2016;474:2181–2187.
Dangin A, Boulat S, Farizon F, Philippot R. Prevention of dislocation risk during hip revision surgery with the dual mobility concept; study of a new generation of dual mobility cups. Surg Technol Int. 2016;29:314–319.
De Martino I, D’Apolito R, Soranoglou VG, Poultsides LA, Sculco PK, Sculco TP. Dislocation following total hip arthroplasty using dual mobility acetabular components A systematic review. Bone Joint J. 2017;99:18–24.
Guyen O, Pibarot V, Vaz G, Chevillotee C, Bejui-Hugues J. Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res. 2009;467:465–472.
Hailer NP, Weiss RJ, Stark A, Kärrholm J. Dual-mobility cups for revision due to instability are associated with a low rate of re-revisions due to dislocation 228 patients from the Swedish Hip Arthroplasty Register. Acta Orthop. 2012;83:566–571.
Hernigou P, Dubory A, Potage D, Roubineau F, Henri C, Lachaniette F. Dual-mobility arthroplasty failure: a rationale review of causes and technical considerations for revision. Int Orthop. 2017;41:481–490.
Heumen M Van, Heesterbeek PJC, Swierstra BA, Hellemondt GG Van, Goosen JHM. Dual mobility acetabular component in revision total hip arthroplasty for persistent dislocation: no dislocations in 50 hips after 1–5 years. J Orthop Traumatol. 2015;16:15–20.
Huten D, Fournier Y, Gicquel T, Bertho P, Basselot F, Hamadouche M. Risk factors for dislocation after revision total hip arthroplasty with a dual-mobility cup. Matched case-control study (16 cases vs. 48 controls). Orthop Traumatol Surg Res. 2019;105:1303–1309.
Jafari SM, Coyle C, Mortazavi SMJ, Sharkey PF, Parvizi J. Revision hip arthroplasty: Infection is the most common cause of failure. Clin Orthop Relat Res. 2010;468:2046–2051.
Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. Clin Orthop Relat Res. 2008;466:389–395.
Lübbeke A, Roussos C, Barea C, Köhnlein W, Hoffmeyer P. Revision total hip arthroplasty in patients 80 years or older. J Arthroplasty. 2012;27:1041–1046.
Mertl P, Combes A, Leiber-wackenheim F, Fessy MH. Recurrence of dislocation following total hip arthroplasty revision using dual mobility cups was rare in 180 hips followed over 7 years. HSS J. 2012;8:251–256.
Migaud H, Common H, Girard J, Huten D, Putman S. Acetabular reconstruction using porous metallic material in complex revision total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res. 2019;105:S53–S61.
Mohaddes M, Cnudde P, Rolfson O, Wall A, Karrholm J. Use of dual-mobility cup in revision hip arthroplasty reduces the risk for further dislocation: analysis of seven hundred and ninety one first-time revisions performed due to dislocation, reported to the Swedish Hip Arthroplasty Register. Int Orthop. 2017;41:583–588.
Mohammed R, Hayward K, Mulay S, Bindi F, Wallace M. Outcomes of dual-mobility acetabular cup for instability in primary and revision total hip arthroplasty. J Orthop Traumatol. 2015;16:9–13.
Paprosky WG, Bradford MS, Younger TI. Classification of bone defects in failed prostheses. Chir Organi Mov. 1994;79:285–291.
Paprosky WG, Burnett RSJ. Assessment and classification of bone stock deficiency in revision total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2002;31:459–464.
Petis SM, Abdel MP, Perry KI, Mabry TM, Hanssen AD, Berry DJ. Long-term results of a 2-stage exchange protocol for periprosthetic joint infection following total hip arthroplasty in 164 hips. J Bone Joint Surg Am. 2019;101:74–84.
Philippeau J, Durand J, Carret J, Leclercq S, Waast D, Gouin F. Dual mobility design socket use in preventing total hip replacement dislocation following tumor resection. Orthop Traumatol Surg Res. 2010;96:2–8.
Saragaglia S, Ruatti R, Refaie D. Relevance of a press-fit dual mobility cup to deal with recurrent dislocation of conventional total hip arthroplasty : a 29-case series. Eur J Orthop Surg Traumatol. 2013;23:431–436.
Sayac G, Neri T, Schneider L, Philippot R, Farizon F, Boyer B. Low revision rates at more than 10 years for dual-mobility cups cemented into cages in complex revision total hip arthroplasty. J Arthroplasty. 2020;35:513–519.
Schneider L, Philippot R, Boyer B, Farizon F. Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res. 2011;97:807–813.
Simian E, Chatellard R, Druon J, Berhouet J, Rosset P. Dual mobility cup in revision total hip arthroplasty: Dislocation rate and survival after 5 years. Orthop Traumatol Surg Res. 2015;101:577–581.
Springer BD, Fehring TK, Griffin WL, Odum SM, Masonis JL. Why revision total hip arthroplasty fails. Clin Orthop Relat Res. 2009;467:166–173.
Yu R, Hofstaetter JG, Sullivan T, Costi K, Howie DW, Solomon LB. Validity and reliability of the paprosky acetabular defect classification hip. Clin Orthop Relat Res. 2013;471:2259–2265.
Zagra L, Caboni E. Total hip arthroplasty instability treatment without dual mobility cups : brief overview and experience of other options. Int Orthop. 2017;41:661–668.
Zahar A, Klaber I, Gerken A-M, Gehrke T, Gebauer M, Lausmann C, Citak M. Ten-year results following one-stage septic hip exchange in the management of periprosthetic joint infection. J Arthroplasty. 2019;34:1221–1226.