Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital

Sebastian S Mukka, Sarwar S Mahmood, Göran O Sjödén, Arkan S Sayed-Noor, Sebastian S Mukka, Sarwar S Mahmood, Göran O Sjödén, Arkan S Sayed-Noor

Abstract

Dislocation remains a major concern after hip arthroplasty. We asked whether dual mobility cups (DMC) would improve early hip stability in patients with high risk of dislocation. We followed 34 patients (21 females, 13 males) treated between 2009 and 2012 with cemented DMC for hip revisions caused recurrent hip prosthetic dislocation or as a primary procedure in patients with high risk of instability. Functional outcome and quality of life were evaluated using Harris Hip Score and EQ-5D respectively. We found that the cemented DMC gave stability in 94%. Seven patients (20%) were re-operated due to infection. One patient sustained a periprosthetic fracture. At follow-up (6 to 36 months, mean 18), the mean Harris hip score was 67 (standard deviation: 14) and mean EQ-5D was 0.76 (standard deviation: 0.12). We concluded that treating patients with high risk of dislocation with DMC can give good stability. However, complications such as postoperative infection can be frequent and should be managed carefully.

Keywords: complications; dislocation; dual mobility cup; hip arthroplasty; outcome; stability.

Figures

Figure 1.
Figure 1.
A) and B) the cup of this total hip prosthesis was revised to dual mobility cup due to recurrent dislocation. The antero-posterior view shows a decreased global offset of the operated side compared to the conta-lateral side while the lateral view shows inadequate anteversion of the cup. These two factors contribute to instability, especially in patients with good range of motion in the operated hip.
Figure 2.
Figure 2.
The Avantage® dual mobility cup. The metal head ranges from 22 mm to 28 mm in diameter depending on the cup size and it is pressed into the polyethylene liner with a special instrument. The liner articulates with the cylindro-spherical metal cup. This figure is the property of Biomet Inc of its affiliates, which have granted their permission for usage only on this publication and solely for educational and scientific purposes.
Figure 3.
Figure 3.
The antero-posterior (A) and lateral (B) views of the radiographs for the Avantageâ dual mobility cup that dislocated. Note the extreme anteversion of the cup and the stem.

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