Long-term outcomes of a dual-mobility cup and cementless triple-taper femoral stem combination in total hip replacement: a multicenter retrospective analysis

Alain Cypres, Arnaud Fiquet, Philippe Girardin, David Fitch, Philippe Bauchu, Olivier Bonnard, Daniel Noyer, Christophe Roy, Alain Cypres, Arnaud Fiquet, Philippe Girardin, David Fitch, Philippe Bauchu, Olivier Bonnard, Daniel Noyer, Christophe Roy

Abstract

Background: The separate design concepts of dual-mobility cups and triple-taper femoral stems were developed to improve survivorship following total hip replacement (THR) by reducing instability/dislocation and enabling enhanced fixation. Successful outcomes at over two decades have been reported with earlier-generation devices based on these concepts. The current study aimed to provide the first long-term results with a unique pairing of later-generation dual-mobility cup and triple-taper cementless femoral stem after a decade of use in patients undergoing THR.

Methods: In this retrospective analysis, records were reviewed for all subjects implanted with this dual-mobility cup/cementless femoral stem combination at three centers between 2002 and 2005. Any subject who had not already had follow-up visit beyond 10 years, was not previously revised, and still living were invited for a single follow-up visit consisting of Merle d'Aubgine Scores, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and standard radiographs.

Results: There were 244 THRs available for analysis. At a mean follow-up of 11.9 years, the Kaplan-Meier survivorship (endpoint: revision for any reason) was 99.1% (95% CI, 97.6-99.7) for the stem and 95.9% (95% CI, 93.1-97.6) for the cup. Merle d'Aubigne Scores were significantly improved from baseline and WOMAC scores were in the satisfactory range at the final follow-up. Radiographic analysis revealed no cases of stem subsidence, no cases of bone hypertrophy, 1 (0.4%) case of bone atrophy, and 3 (1.2%) cases of osteolysis around the stem. No subjects had radiolucent lines greater than 1 mm in any femoral Gruen zone. Evidence of cup migration was seen in 1 (0.4%) subject and 1 (0.4%) subject had evidence of osteolysis that was seen in Gruen zones I, II, IV, and V.

Conclusions: This combination of a later-generation dual-mobility cup and cementless triple-taper stem was associated with excellent survivorship and satisfactory functional outcomes at over 10 years follow-up.

Trial registration: ClinicalTrials.gov, NCT02648152. Date of registration: January 6, 2016. Retrospectively registered.

Keywords: Dual-mobility cup; Outcomes; Polarcup; Polarstem; Survivorship; Total hip replacement; Triple-taper stem.

Conflict of interest statement

AC, AF, PG, PB, OB, DN, and CR all hold patents for the study devices mentioned in this manuscript. DF was an employee of Smith & Nephew at the time this manuscript was developed.

Figures

Fig. 1
Fig. 1
Dual-mobility Polarcup system
Fig. 2
Fig. 2
Side view of the triple-taper Polarstem

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