Can cemented dual-mobility cups be used without a reinforcement device in cases of mild acetabular bone stock alteration in total hip arthroplasty?

• Published in: Orthopaedics & traumatology, surgery & research Vol. 101; no. 8; pp. 923 - 927
• Main Authors: Haen, T.X, Lonjon, G, Vandenbussche, E
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.12.2015
• Subjects: Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Bone cement; Bone Cements; Cohort Studies; Dislocation; Dual mobility; Female; Follow-Up Studies; Hip arthroplasty; Hip Joint - physiopathology; Hip Prosthesis - adverse effects; Humans; Instability; Loosening; Male; Middle Aged; Orthopedics; Osteoarthritis, Hip - surgery; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Reoperation - methods; Retrospective Studies; Risk; Risk Factors; Surgery; Time Factors; Instability; Bone cement; Loosening; Hip arthroplasty; Dual mobility; Dislocation
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2015.09.027

Abstract Introduction Cemented versions of dual-mobility cups (DMCs), helpful in cases of bone stock alteration, are usually used in association with a reinforcement device. To simplify the intervention in elderly subjects or those with a poor bone stock, the cups can be cemented directly into the bone, but the long-term result remains uncertain. We conducted a retrospective study in this population so as to: (1) assess whether cemented fixation of a DMC without a reinforcement device leads to a higher loosening rate, (2) confirm its efficacy in preventing dislocations in subjects at high risk of instability, and (3) measure the functional results. Hypothesis Cemented fixation of a DMC is reliable in cases of moderate alteration of bone stock. Material and methods Sixty-four patients (66 hips) undergoing implantation of a cemented DMC (Saturne™) without a reinforcement device were included in this single-center retrospective study. Their mean age was 79.8 years (range, 40–95 years). The indications varied: hip osteoarthritis (30.3%), prosthesis revision (44.0%), and trauma (25.8%). The patients were evaluated radiologically and clinically at follow-up. The main evaluation criterion was the revision rate for aseptic loosening. Dislocations, the infection rate, and the Postel Merle d’Aubigné (PMA) score were noted. Results At the mean follow-up of 4.2 years, three (4.6%) patients had been lost to follow-up and 22 (33.3%) had died. There was one case of aseptic loosening (1.5%). Cup survival was 98% at 5 years (95%CI [94–100]). There were no dislocations. There was one revision for infection. The mean PMA score was 15.5 (range, 9–18). Discussion The frequency of acetabular loosening was comparable to the frequency in cemented DMCs with a reinforcement device. A cemented DMC without a reinforcement device is possible and is a simple and viable option when there is moderate bone stock alteration. Level of evidence IV, retrospective cohort study.