The use of dual mobility cups in revision total hip arthroplasty for failed large head metal-on-metal bearings

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Serval ID
serval:BIB_C0A32D5E33CD
Type
PhD thesis: a PhD thesis.
Collection
Publications
Institution
Title
The use of dual mobility cups in revision total hip arthroplasty for failed large head metal-on-metal bearings
Author(s)
Meriem Samir
Director(s)
Wegrzyn Julien
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2024
Language
english
Abstract
Purpose Revision of failed large head metal-on-metal (MoM) total hip arthroplasty (THA) is a challenging procedure par- ticularly 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.
Methods 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.
Results 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%).
Conclusion The use of DMC is a reliable option to prevent instability and ensure a stable acetabular reconstruction in revi- sion 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.
Keywords
Total hip arthroplasty (THA), Adverse reaction to metal debris (ARMD), Dual mobility cup (DMC)
Create date
10/06/2024 11:26
Last modification date
03/07/2024 10:49
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