A dual-mobility cup reduces risk of dislocation in isolated acetabular revisions

Abstract

Background: Isolated acetabular revisions using standard cups are at risk of dislocation. The introduction of a nonconstrained dual-mobility cup was designed to improve prosthetic stability without increasing loosening rates, but it is unclear whether the risk of dislocation is reduced.

Questions/purposes: We therefore determined: (1) if the rate of dislocation in isolated acetabular revisions is lower with a dual-mobility cup, (2) implant survival, (3) patient function, and (4) radiographic incidence of migration, loosening, and osteolysis.

Methods: We prospectively followed 33 selected patients who underwent isolated acetabular revisions with a minimum of 2 years' followup (mean, 3 years; range, 2-5 years). In 24 patients a stainless steel dual-mobility cup was cemented into an antiprotrusio cage, whereas in nine we used a hyaluronan dual-mobility revision cup with a foramen hook and superior and posterior flanges screw fixations. We determined Harris hip (HHS) and WOMAC scores and examined radiographs for migration, loosening, and osteolysis.

Results: There were no dislocations. Survivorship rates of the femoral and acetabular components were 97% at 5 years; the rerevision rate for any reason was 3%. At last followup, the mean HHS increased from 48 points preoperatively to 86 points. No patients had progressive osteolysis, component migration, or loosening on radiographs.

Conclusion: In this select group of isolated acetabular revisions, our data suggest the use of a dual-mobility cup reduced the risk of dislocation without increasing loosening from 2 to 5 years.

Level of evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

The stainless steel dual-mobility cup (Avantage®; Biomet, Warsaw, IN, USA) that is cemented in an antiprotrusio cage (Contour®; Smith & Nephew, Memphis, TN, USA) is shown.

Fig. 2

The diagram of dual-mobility cup shows (1) articulation between the head and liner and (2) articulation between the liner and cup. The cup must be cemented into an antiprotrusio cage.

Fig. 3A–C

A 65-year-old woman had loosening of an oval cementless cup. (A) Her preoperative AP view shows the massive acetabular defect. (B) The immediate postoperative AP view shows the revision THA with an antiprotrusio cage and a cemented dual-mobility cup. (C) A radiograph taken 4 years after revision shows excellent bone ingrowth without evidence of loosening.

Fig. 4

An hydroxyapatite-coated stainless steel dual-mobility revision cup (Avantage® Revision; Biomet Warsaw, IN, USA) is shown.

Fig. 5A–C

A 73-year-old woman had loosening of a Charnley cemented cup. (A) Her preoperative AP view is shown. (B) An intraoperative photograph shows how the polyethylene of the dual-mobility cup was assembled in situ. (C) A postoperative AP view taken 2 years after revision is shown.