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

Roberto Civinini, Christian Carulli, Fabrizio Matassi, Lorenzo Nistri, Massimo Innocenti
Clinical Orthopaedics and related Research 2012, 470 (12): 3542-8

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.

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