Dual Mobility cup in thr

1. DUAL MOBILITY CUPS – KHOULA
EXPERIENCE
Dr. Jatinder S. Luthra MS, DNB, MRCS
Dr. Amur Riyami
Dr. Mohamad Kasim Allami FRCS , FRCS ( Trauma & Ortho)

2. • THR – 1.5 million
worldwide
• One of most succesful
procedure

3. 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

4. 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
arthroplasty
Berry et al JBJS 2004

5. Surgical
Factors
Implant
Factors
Patient
Factors
Impingement
Jump Distance
Reduction

6. Dual Mobility - Concept
• Gilles Bosquet and Raoul Lambart - 1975
Based on
• Low friction arthroplasty ( Charnley)
• Low dislocation rate – Large Femoral Head
(Mackee Farrar)

7. • Larger femoral head reduced dislocation
- Better head neck ratio – better movement
- Greater translocation is required before
dislocation

8. • 3 components & 3 joints
• - Acetabular socket
(cemented / cementless)
• Poly Liner
• Metal / Ceramic head
• Liner is free in acetabular
component

9. • Small Joint – Poly liner &
head
• Large joint – Poly liner metal
cup
Recruitment Phenomenon

10. Indications
• > 65 yrs
• Prior Hip Surgery
• Neuromuscular disease
• Cognitive Dysfunction
• ASA > 3
• Revision THR

11. Khoula Experience
• Early results
• Mar 2011 – Till Date

12. • 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

13. Total Case - 47
Primary
THR
Revision
THR
22 27
Total Cases 47
Primary
THR 22
Revision
THR 25

14. Primary THR
12
7
2
1
Primary THR 22
OA
# Neck femur
# Acetabulum
Sickler
Osteoarthritis - 12
# Neck Femur – 7
# Acetabulum – 2
Sickler - 1

15. Revision THR
5
93
2
4
2
Revision THR 25
Failed DHS
Failed Hemi
Infection
Periprosthetic
fracture
Revision THR
Failed
osteosynthesi
Failed DHS - 5
Failed Hemi - 9
Infection - 3
Periprosthetic
fracture - 2
Revision THR - 4
Failed
Osteosynthesis - 2

16. • Posterior approach
• Avantage Privelege Cup system ( Biomet)
• Patients with high risk of post op dislocation

17. Acetabular Size
Size 44 - 25
Size 46 – 10
Size 48 – 5
Size 50 - 4
Size 52 - 3
25
10
5
4
3
0
5
10
15
20
25
30
44 46 48 50 52
Acetabular Sizes
Acetabular
Sizes

18. Femoral Sizes
8
26
10
2
1
0
5
10
15
20
25
30
7 9 11 13 15
AxisTitle
Axis Title
Femoral sizes
Femoral sizes
Size 7 - 8
Size 9 - 26
Size 11 - 10
Size 13 - 2
Size 15 - 1

19. 0
5
10
15
20
25
30
35
40
No Of Cases
No Of Cases
Cemented – 36
(76%)
Uncemented - 2
(4%)
Hybrid – 9 ( 19%)

20. Fluoroscopic evaluation
• 7 pt agreed in follow up to undergo
fluoroscopic evaluation
• No impingement at extremes of movement

21. Fluoroscopic evaluation

22. Complications
• Deep infection – 1
• Dislocation – 1
• Mortality – 1
• Intraop Fracture - 2

23. Results
• Follow up range from 4mths to 42mths
• Good early Results in high risk cases in Omani
population
• Dislocation - 2% ( Revision THR)

24. Radiological Evaluation
• No reported cases of osteolysis
• No signs of aseptic loosening
• Fluoroscopy demonstrates – no impingement

25. Dual mobility cup - Sickler

26. Dual mobility cup – Failed
Osteosynthesis

27. Dual mobility cup - # Neck Femur

28. Dual mobility cup – Failed DHS

29. Dual mobility cup – Failed Hemi

30. Dual mobility cup - Arthritis

31. Dual mobility cup – Post Infection

32. Dual mobility cup – Old Acetab. #

33. Dual mobility cup – Revision THR

34. Intraprosthetic dislocation
Concern about early Intraprosthetic Dislocation in Dual Mobility Implants
Marc et Al JBJS Case Connector 2013
Femoral head dislodgement complicating use of a Dual Mobility Prosthesis for
recurrent Instability
Banzhof et al Journal of Arthroplasty 2010
Severe Metallosis owing to intraprosthetic dislocation in a failed Dual – mobility
cup Primary Total Hip Arthroplasty
Mohammad et al Journal of Arthroplasty 2011

35. 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

36. 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

37. 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

38. Dual Mobility cup in Revision THR
• Dislocation after conventional THR –
dislocation 5% to 30 %
 Muscular insufficiency
 Bone loss Aggressive capsulectomy
 Difficulty in implant positioning

39. 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

40. 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

41. 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

42. Dual mobility cup in spastic disorder
• Dislocation rate – 14 %
• Sanders et al – 10 hips – no dislocation – 3 yrs

43. 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

44. THANK YOU