DUAL MOBILITY CUPS – KHOULA EXPERIENCE

Dr. Jatinder S. Luthra MS, DNB, MRCS

Dr. Amur Riyami

Dr. Mohamad Kasim Allami FRCS , FRCS ( Trauma & Ortho)

• THR – 1.5 million worldwide

• One of most succesfulprocedure

Rate of THR grow by 174% by 2030

The Burden of Hip Osteoarthritis in The United States : epidemiologi and economic consideration NHO et al JAAOS 2013

THR – Dislocation

• Cumulative risk of dislocation increases with time

Posterolateral approach

> 70 years

Head Diameter

Female Sex

The cumulative long –term risk of dislocation after primary Charnley total hip arthroplastyBerry et al JBJS 2004

Surgical Factors

Implant Factors

Patient Factors

Impingement

Jump Distance Reduction

Dual Mobility - Concept

• Gilles Bosquet and Raoul Lambart - 1975

Based on

• Low friction arthroplasty ( Charnley)

• Low dislocation rate – Large Femoral Head (Mackee Farrar)

• Larger femoral head reduced dislocation

- Better head neck ratio – better movement

- Greater translocation is required before dislocation

• 3 components & 3 joints

• - Acetabular socket (cemented / cementless)

• Poly Liner

• Metal / Ceramic head

• Liner is free in acetabularcomponent

• Small Joint – Poly liner & head

• Large joint – Poly liner metal cup

Recruitment Phenomenon

Indications

• > 65 yrs

• Prior Hip Surgery

• Neuromuscular disease

• Cognitive Dysfunction

• ASA > 3

• Revision THR

Khoula Experience

• Early results

• Mar 2011 – Till Date

• Total 47 cases

• Male – 18• Female – 29

• Age range from – 23 yrs to 91 yrs –

• Mean age 61 yrs

• Patients < 40 yrs – 5• Patients > 40 Yrs - 42

• Multisurgeon study

Patients - 47

Male - 18

Female - 29

Total Case - 47

PrimaryTHR

RevisionTHR

22 27

Total Cases 47

PrimaryTHR 22

RevisionTHR 25

Primary THR

127

21

Primary THR 22

OA

# Neck femur

# Acetabulum

Sickler

Osteoarthritis - 12

# Neck Femur – 7

# Acetabulum – 2

Sickler - 1

Revision THR

5

93

2

4

2

Revision THR 25

Failed DHS

Failed Hemi

Infection

Periprostheticfracture

Revision THR

Failedosteosynthesi

Failed DHS - 5

Failed Hemi - 9

Infection - 3

Periprostheticfracture - 2

Revision THR - 4

Failed Osteosynthesis - 2

• Posterior approach

• Avantage Privelege Cup system ( Biomet)

• Patients with high risk of post op dislocation

Acetabular Size

Size 44 - 25

Size 46 – 10

Size 48 – 5

Size 50 - 4

Size 52 - 3

25

10

54

3

0

5

10

15

20

25

30

44 46 48 50 52

Acetabular Sizes

AcetabularSizes

Femoral Sizes

8

26

10

21

0

5

10

15

20

25

30

7 9 11 13 15

Axi

s Ti

tle

Axis Title

Femoral sizes

Femoral sizes

Size 7 - 8

Size 9 - 26

Size 11 - 10

Size 13 - 2

Size 15 - 1

0

5

10

15

20

25

30

35

40

No Of Cases

No Of Cases

Cemented – 36 (76%)

Uncemented - 2 (4%)

Hybrid – 9 ( 19%)

Fluoroscopic evaluation

• 7 pt agreed in follow up to undergo fluoroscopic evaluation

• No impingement at extremes of movement

Fluoroscopic evaluation

Complications

• Deep infection – 1

• Dislocation – 1

• Mortality – 1

• Intraop Fracture - 2

Results

• Follow up range from 4mths to 42mths

• Good early Results in high risk cases in Omani population

• Dislocation - 2% ( Revision THR)

Radiological Evaluation

• No reported cases of osteolysis

• No signs of aseptic loosening

• Fluoroscopy demonstrates – no impingement

Dual mobility cup - Sickler

Dual mobility cup – Failed Osteosynthesis

Dual mobility cup - # Neck Femur

Dual mobility cup – Failed DHS

Dual mobility cup – Failed Hemi

Dual mobility cup - Arthritis

Dual mobility cup – Post Infection

Dual mobility cup – Old Acetab. #

Dual mobility cup – Revision THR

Intraprosthetic dislocation

Concern about early Intraprosthetic Dislocation in Dual Mobility ImplantsMarc et Al JBJS Case Connector 2013

Femoral head dislodgement complicating use of a Dual Mobility Prosthesis for recurrent InstabilityBanzhof et al Journal of Arthroplasty 2010

Severe Metallosis owing to intraprosthetic dislocation in a failed Dual – mobility cup Primary Total Hip ArthroplastyMohammad et al Journal of Arthroplasty 2011

Dual mobility cups in primary THR

• 10 years follow up survivorship – 94% – 97%

• Dislocation rate 0%-1%

• Causes of failure – Aseptic loosening

• Excessive PE wear

Study Hips Survivorship Years

Aubriot , 1993

100 97% 5

Farizon 1998 135 95.4% 10

Leclerc, 1999 153 96% 10

Philippot,2004

106 94.6% 10

Philippot, 2006

100 95% 10

Dislocation in Primary THR – Dual Mobility Cup

Study No of Cases No of Dislocation

Philippot, 2004 106 0

Aubriot, 1993 110 1

Vanel, 2003 127 1

Bejui- Hughes, 2006 167 0

Philippot, 2006 70 0

Dual Mobility cup in Revision THR

• Dislocation after conventional THR –dislocation 5% to 30 %

Muscular insufficiency

Bone loss Aggressive capsulectomy

Difficulty in implant positioning

Dislocation in Revision THR – Dual Mobility Cup

Study No Of Revision THR No of Dislocation

Aubriot, 1995 13 0

Beguin, 2002 42 0

SFHG, 2006 403 8

Guyen, 2009 54 3

Dual mobility in fracture neck femur

• Mean Dislocation rate - 10 % ( conventional THR)

• Tarasevicius et al compared dislocation rates for DM cup and conventional cups

At 1 year 14 % dislocation in conventional gp

and no dislocation in DM gp

Dual mobility in tumor resection

• Bone loss & soft tissue compromise – high dislocation rate

• Philippeau et al – 9 % dislocation in 71 pt with Tumor resection

• Can be further reduced by reattaching abductors and avoid gluteus max resection

Dual mobility cup in spastic disorder

• Dislocation rate – 14 %

• Sanders et al – 10 hips – no dislocation – 3 yrs

Summary

• Excellent implant for Thr in high risk patients in middle east population

• Constrained liners are not needed

• Elderly pt with fracture neck femur – Dual mobility cup is treatment of choice

THANK YOU