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Review
. 2021 Nov 24;13(11):e19858.
doi: 10.7759/cureus.19858. eCollection 2021 Nov.

Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty: The Unforeseen Complication

Shady Hermena  1 , Waleed Tawfeek  1 , Paul Latimer  1
Affiliations
Review

Intraprosthetic Dislocation of Dual-Mobility Total Hip Arthroplasty: The Unforeseen Complication

Shady Hermena et al. Cureus. .

Abstract

Total hip arthroplasty (THA) is one of the most successful and widely accepted orthopedic procedures. Instability after THA is one of the most significant postoperative complications. Dual-mobility THA components were introduced in 1974 to overcome the risk of instability by increasing the jump distance. Dual-mobility bearings couple two articulations, namely, one between a 22-28 mm prosthetic head and polyethylene liner and another larger articulation between the polyethylene liner and the metal cup. Dislocation of the polyethylene liner and the consequent direct articulation between the prosthetic head and metal cup is recognized as intraprosthetic dislocation (IPD). This mode of THA failure is specific to dual-mobility implants. Despite the reduced incidence of IPD in modern dual-mobility implants compared to the early designs, iatrogenic IPD can occur during closed reduction of dislocated polyethylene liner-metal cup articulation. IPD requires timely diagnosis and early surgical intervention to minimize the necessity of major revision surgeries. This study presents a comprehensive review for dual-mobility-bearing THA, including the history and biomechanics, and focuses on the pathomechanics, diagnosis, and management of IPD.

Keywords: dual mobility; dual-mobility bearings; dual-mobility cup; dual-mobility total hip arthroplasty; intraprosthetic dislocation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anteroposterior X-ray of the right hip showing dislocated polyethylene liner-metal cup articulation of dual-mobility total hip arthroplasty. The polyethylene liner is attached to the prosthetic head, as demonstrated by the green arrows.
Figure 2
Figure 2. Anteroposterior pelvic X-ray showing intraprosthetic dislocation. The dislocated polyethylene liner is demonstrated by green arrows and appears as “the bubble sign.”
Figure 3
Figure 3. Fluoroscopy image of the right hip showing the eccentric position of the prosthetic head within the acetabular cup.
Figure 4
Figure 4. A cross-section image from a pelvic CT scan showing the dislocated polyethylene liner demonstrated by green arrows.
CT: computed tomography
See this image and copyright information in PMC

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