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Review
. 2019 Sep 3;4(9):541-547.
doi: 10.1302/2058-5241.4.180045. eCollection 2019 Sep.

Dual mobility total hip arthroplasty: should everyone get one?

William G Blakeney  1   2 , Jean-Alain Epinette  3 , Pascal-André Vendittoli  2   4
Affiliations
Review

Dual mobility total hip arthroplasty: should everyone get one?

William G Blakeney et al. EFORT Open Rev. .

Abstract

Hip instability following total hip arthroplasty (THA) remains a major challenge and is one of the main causes of revision surgery.Dual mobility (DM) implants have been introduced to try to overcome this problem. The DM design consists of a small femoral head captive and mobile within a polyethylene liner.Numerous studies have shown that DM implants reduce the rate of dislocation compared to fixed-bearing inserts.Early designs for DM implants had problems with wear and intra-prosthetic dislocations, so their use was restricted to limited indications.The results of the latest generation of DM prostheses demonstrate that these problems have been overcome. Given the results of these studies presented in this review, surgeons may now consider DM THA for a wider patient selection. Cite this article: EFORT Open Rev 2019;4:541-547. DOI: 10.1302/2058-5241.4.180045.

Keywords: dislocation; dual mobility; total hip arthroplasty.

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Conflict of interest statement

ICMJE Conflict of interest statement: J-AE reports a contractual agreement for scientific support on arthroplasty matters with Stryker, with no relation with the current publication. P-AV reports consultancy for Medacta, Microport, Stryker and Ethicon; expert testimony for Kugler Kandestin regarding metal on metal bearing devices class actions; grants or grants pending from Medacta, Ethicon, Stryker and Zimmer; payment for lectures including service on speakers’ bureaus from Medacta, and Stryker and Ethicon; payment for manuscript preparation from Microport for Preserve femoral stem (as one of the designer surgeons), a paper submitted to Hip International Journal; royalties from Microport for Profemur and Preserve femoral stem; and payment for development of education presentations from Ethicon and Johnson and Johnson for Project Move, a day surgery program, all outside the submitted work WB declares no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Typical design of a ‘modern’ dual mobility (DM) cup, with a large polyethylene (PE) liner ball articulating with a highly polished metallic acetabular shell.
Fig. 2
Fig. 2
The three articulating surfaces in dual mobility (DM) cups: (a) and (b) demonstrate these three bearings as the large one (a.1) between the polyethylene (PE) liner and metallic shell, the small one (a.2) between the femoral head and liner, and the so-called third articulation (a.3) between the femoral neck and the PE liner; (c) illustrates the rotation of the PE liner upon contact with the femoral neck while (d) shows the relationship during movements between the femoral neck on the one hand, and first the liner, and second the rim of the metallic shell.
Fig. 3
Fig. 3
In fixed-bearing cups, the articulating surface is generally hemispheric (a). Conversely, in dual mobility cups, the shell design should be supra-hemispheric (as shown in b), to ensure an optimal retention of the liner inside the metallic shell.
Fig. 4
Fig. 4
Comparative rates of dislocation over time based upon fixed bearings (FB, in blue) versus dual mobility (DM) cups with two potential relative risks DM/FB of 0.4 (in red) and of 0.2 (in orange).
See this image and copyright information in PMC

References

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