Dual-mobility cups for revision due to instability are associated with a low rate of re-revisions due to dislocation

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Abstract

Background and purpose

Revision total hip arthroplasty (THA) due to recurrent dislocations is associated with a high risk of persistent instability. We hypothesized that the use of dual-mobility cups would reduce the risk of re-revision due to dislocation after revision THA.

Patients and methods

228 THA cup revisions (in 228 patients) performed due to recurrent dislocations and employing a specific dual-mobility cup (Avantage) were identified in the Swedish Hip Arthroplasty Register. Kaplan-Meier survival analysis was performed with re-revision due to dislocation as the primary endpoint and re-revision for any reason as the secondary endpoint. Cox regression models were fitted in order to calculate the influence of various covariates on the risk of re-revision.

Results

58 patients (25%) had been revised at least once prior to the index cup revision. The surgical approach at the index cup revision was lateral in 99 cases (44%) and posterior in 124 cases (56%). Median follow-up was 2 (0–6) years after the index cup revision, and by then 18 patients (8%) had been re-revised for any reason. Of these, 4 patients (2%) had been re-revised due to dislocation. Survival after 2 years with the endpoint revision of any component due to dislocation was 99% (95% CI: 97–100), and it was 93% (CI: 90–97) with the endpoint revision of any component for any reason. Risk factors for subsequent re-revision for any reason were age between 50–59 years at the time of the index cup revision (risk ratio (RR) = 5 when compared with age > 75, CI: 1–23) and previous revision surgery to the relevant joint (RR = 1.7 per previous revision, CI: 1–3).

Interpretation

The risk of re-revision due to dislocation after insertion of dual-mobility cups during revision THA performed for recurrent dislocations appears to be low in the short term. Since most dislocations occur early after revision THA, we believe that this device adequately addresses the problem of recurrent instability. Younger age and prior hip revision surgery are risk factors for further revision surgery. However, problems such as potentially increased liner wear and subsequent aseptic loosening may be associated with the use of such devices in the long term.

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Most cited references 34

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An analysis of the risk of hip dislocation with a contemporary total joint registry.

Robert Namba, Donald Fithian, Thomas W Barber … (2006)

Dislocation rates after total hip arthroplasty in a community setting have not been well documented. We used a community based joint registry to evaluate hip dislocations that occurred within 1 year after total hip arthroplasty. We evaluated patient, implant, and technical factors associated with dislocation, including primary versus revision surgery, femoral head size (28 mm versus > or = 32 mm), operative time, surgeon volume, surgical approach, age, gender, diagnosis, American Society of Anesthesiologists (ASA) classification, and body mass index (BMI). There were 1693 primary total hip arthroplasties and 277 revision procedures performed from 2001-2003. The overall dislocation rate was 1.7% for primary total hip arthroplasties and 5.1% for revision procedures. Patients with ASA scores of 3 or 4 had a 2.3-fold dislocation increase compared with patients with scores of 1 or 2. Patients with rheumatoid arthritis had an increased risk of dislocation. The dislocation rates for primary total hip arthroplasty were 2% for 28 mm heads and 0.7% for heads > or = 32 mm. The surgeon's patient volume, surgical approach, operative time, and body mass index had no effect on dislocation.

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Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips.

J R Philippot, Jean Geringer, Frédéric Farizon … (2012)

The longest follow-up dual mobility series from inventor Gilles Bousquet focussing on implant survival and the incidence of dislocation. This was a retrospective study from 1985 to 1990, on 240 hips using a PF® modular femoral stem and a dual mobility Novae® tripodal socket (SERF). The 22-year follow-up global survival rate was 74%. No dislocation occurred, 41 hips were revised, including ten retentive failures (RF), 12 hips were lost to follow-up, 87 patients (99 hips) died without revision, and 90 hips were still in situ. The dual mobility socket global survival rate is comparable to similar series. The 0% dislocation rate demonstrates the success of dual mobility with regard to implant stability. The main issues were cup fixation, which might be improved by the use of macrostructures and HA coating, and osteolytic lesions, caused by polyethylene wear. Traditionally suitable for patients older than 60 years, dual mobility might be extended for use in patients over 50.

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Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement.

J. Barrett, Robert Poss, Nizar Mahomed … (2002)

The lengths of acute hospital stays following total hip replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total hip replacement would facilitate recognition and management of these adverse events. We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total hip replacement for a reason other than a fracture (58,521 patients) or had had revision total hip replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months. Of the patients who had had a primary total hip replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total hip replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively. The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total hip replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total hip replacement. Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

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Author and article information

Journal

Journal ID (nlm-ta): Acta Orthop

Journal ID (iso-abbrev): Acta Orthop

Journal ID (publisher-id): ORT

Title: Acta Orthopaedica

Publisher: Informa Healthcare

ISSN (Print): 1745-3674

ISSN (Electronic): 1745-3682

Publication date (Print): December 2012

Publication date (Electronic): 26 November 2012

Volume: 83

Issue: 6

Pages: 566-571

Affiliations

¹Department of Orthopaedics , Institute of Surgical Sciences, Uppsala University Hospital, Uppsala

²Department of Molecular Medicine and Surgery , Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm

³Department of Clinical Sciences , Karolinska Institute at Danderyd Hospital, Stockholm

⁴Department of Orthopaedics , Institute of Surgical Science, Sahlgrenska University Hospital, Göteborg University, Mölndal, Sweden.

Author notes

Correspondence: nils.hailer@ 123456surgsci.uu.se

Article

Publisher ID: ORT_A_742395_O

DOI: 10.3109/17453674.2012.742395

PMC ID: 3555442

PubMed ID: 23116439

SO-VID: 223a4002-2857-4dac-91b6-81959089a8a3

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.

History

Date received : 16 April 2012

Date accepted : 30 August 2012

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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

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Abstract

Background and purpose

Patients and methods

Results

Interpretation

Related collections

Orthopedics

Most cited references 34

An analysis of the risk of hip dislocation with a contemporary total joint registry.

Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips.

Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement.

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Cited by 22