The use of dual mobility cups in revision total hip arthroplasty for failed large head metal-on-metal bearings.
Adverse reaction to metal debris (ARMD)
Dual mobility cup (DMC)
Total hip arthroplasty (THA)
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
01 Nov 2023
01 Nov 2023
Historique:
received:
03
07
2023
accepted:
13
10
2023
medline:
1
11
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
aheadofprint
Résumé
Revision of failed large head metal-on-metal (MoM) total hip arthroplasty (THA) is a challenging procedure particularly to reconstruct acetabular bone defect due to osteolysis and to achieve hip stability due to soft tissue damages, both potentially caused by adverse reaction to metal debris (ARMD). This study aimed to evaluate the outcome of dual mobility cup (DMC) constructs in revision THA for failed large head MoM bearings with a special attention to the occurrence of dislocation or re-revision. Between 2015 and 2019, 57 patients (64 THAs, 41 men, mean age = 65 ± 10 years) underwent revision for MoM THA with the use of DMC were prospectively included in our total joint registry. Mean time to revision was 11 ± 2.5 years. The causes for revision were adverse reaction to metal debris (ARMD) in 49 THAs (76%), painful hip with elevated blood cobalt-chromium ions in seven (11%), and acetabular aseptic loosening in eight (13%). The revision was complete in 22 THAs (34%) and acetabular only in 42 (66%). Clinical and radiographic outcomes, complications, and re-revisions were evaluated at most recent follow-up. At mean follow-up of six ± 1.5 years, the pre- to postoperative Harris Hip Score improved from 74 ± 19 to 92 ± 4 (p = 0.004). Complications occurred in 11 cases (17%): five dislocations (8%), three periprosthetic infections (5%), two aseptic loosening of the acetabular component (3%), and two periprosthetic fractures (3%). Re-revision was required in six cases (9%). The use of DMC is a reliable option to prevent instability and ensure a stable acetabular reconstruction in revision THA for failed large head MoM bearings. However, dislocation after revision remains a concern, particularly in cases of severe soft tissue damage related to ARMD.
Identifiants
pubmed: 37907694
doi: 10.1007/s00264-023-06017-z
pii: 10.1007/s00264-023-06017-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
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