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Anatomic dual mobility compared to modular dual mobility in primary total hip arthroplasty: a matched cohort study.

ABSTRACT: Background:Dual mobility (DM) has been used in primary total hip arthroplasty recently for their low dislocation rates, low revision rates, and improved patient functional outcomes. We compared 2 DM systems, anatomic dual mobility (ADM; Stryker, Mahwah, NJ) and modular dual mobility (MDM; Stryker, Mahwah, NJ), to determine differences in dislocation rates, revision rates, and patient outcome scores. Methods:The study was a single-center matched retrospective review of prospectively collected data of patients who underwent primary total hip arthroplasty surgery with an ADM or MDM system by a single surgeon from 2012 to 2017. Demographics, operative details, postoperative patient-reported outcomes, and clinical outcomes were recorded. A Kaplan-Meier survivorship curve to compare survival time between groups was collected as well. Results:Five hundred seventy-four patients were included in the study with 287 patients matched in each group with mean 2.86 years of follow-up. The dislocation rate in each cohort was 0%, the acetabular-specific revision rate was 0%, and in each cohort, overall revision rate in each cohort was 1.7%. In general, patient-reported outcomes were similar for each group (Harris Hip Score Pain (P = .919), Harris Hip Score Function (P = .736), Western Ontario and McMaster Universities Osteoarthritis Index (P = .139), Pain Visual Analog Scale (P = .146), Veterans RAND 12-Item Health Survey (P = .99), University of California, Los Angeles (P = .417), and Harris Hip Score Total (P = .136). There was a slight clinically insignificant increase in hip flexion between the cohorts favoring the ADM group (98.6 ± 9.8 vs 94.0 ± 9.7, P < .001). Conclusions:Both DM systems had similar patient-reported outcomes that were quite favorable. At 2.86 years of follow-up, neither the ADM nor MDM systems demonstrated dislocation, and both had low acetabular-specific and overall revision rates in this matched cohort study.

SUBMITTER: Dubin JA

PROVIDER: S-EPMC6920720 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Project description:The concept of a dual mobility (DM) cup has been in existence for more than 40 years and was initially popularized in Europe. Only recently has it started to garner attention in the United States. Its design, consisting of a small femoral head articulating within a larger polyethylene (PE) insert, which articulates with an outer shell, has found increasing use in patients that are at risk for post-operative dislocations. This case report describes a case of recurrent total hip arthroplasty (THA) dislocation managed with the implantation of a DM cup with an acute intraprosthetic dislocation of the DM construct.A 52-year-old woman underwent an uneventful left THA through a posterior approach. Within 6 weeks of her surgery, she had four dislocations, managed with closed reductions. She then underwent an open revision of her acetabular component with conversion to a DM construct. 5 weeks after her revision, she had another dislocation treated with closed reduction in the operating room, with the resultant eccentric location of the femoral head in the acetabular component. Computed tomography (CT) confirmed intraprosthetic dislocation with the PE liner lodged in the gluteal tissue. She was taken to the operating room with a plan to revise her acetabular component to another DM construct, but with an increase in the anteversion despite initial anteversion being "appropriate" on CT imaging. Intraoperatively, the PE liner was embedded in gluteal tissue as depicted on the CT. The abductors were intact. There was no impingement in extension and maximal external rotation when trialed with a conventional head/liner construct. A new DM construct was then implanted.Intraprosthetic dislocation is a rare occurrence and unique complication to DM constructs. It is not common in the short-term setting postoperatively to our knowledge, and this case report represents an early report of intraprosthetic dislocation in the literature. Care should be taken during reduction of dislocated DM constructs to avoid intraprosthetic dislocations. Open revisions can be managed with revisions to another DM construct or to a constrained liner construct to maximize stability.

Project description:BackgroundGroin pain is a common long-term complication of total hip arthroplasty (THA). Femoral head size has been proposed as one of the primary causes. The implants used in dual mobility (DM) THA have large outer-bearing articulations, which could increase the risk of post-operative groin pain. Hip resurfacing (HR), too, has been shown to be associated with a risk of groin pain.Questions/purposesThe goals of this study were to compare the incidence of groin pain at 1 year after hip arthroplasty in patients with different femoral head diameters and in patients undergoing conventional THA, DM THA, and HR.MethodsAfter combing an institutional registry for all patients who had undergone THA or HR for primary hip osteoarthritis, we included 3193 patients in the analysis; 2008 underwent conventional THA, 416 underwent DM THA, and 769 underwent HR. We used logistic regression modeling to analyze the relation of groin pain at 1 year after surgery to patient demographics and clinical characteristics, including age, sex, body mass index (BMI), University of California at Los Angeles activity score at 1 year after surgery, bearing couple, and the ratio of acetabular diameter to femoral head diameter. We also measured cup inclination and anteversion in a subset of patients with and without groin pain at 1 year to assess whether pain could be related to implant position.ResultsOverall, 8.7% of patients reported groin pain at 1 year. Patients with groin pain were younger and had lower BMIs. There were increased odds of groin pain with a greater cup-to-head ratio, although DM implants, interestingly, were not significantly associated with groin pain; this may be attributable to so much of their movement taking place inside the implant. Subgroup analysis measuring cup inclination and anteversion showed no difference in cup position between patients with and without pain.ConclusionIn this population of hip arthroplasty patients, the incidence of groin pain 1 year after surgery did not differ among patients undergoing DM and conventional THA; DM THA in particular was not associated with a higher risk of groin pain, despite its comparatively larger femoral head sizes. HR, on the other hand, was associated with a higher risk of pain. Appropriate implant sizing and bearing couple choice may optimize the functional benefit of THA.

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Anatomic dual mobility compared to modular dual mobility in primary total hip arthroplasty: a matched cohort study.

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