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

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.

• Authors: T X Haen, G Lonjon, E Vandenbussche
• Journal: Orthopaedics & traumatology, surgery & research : OTSR (Orthop Traumatol Surg Res) Vol. 101 Issue 8 Pg. 923-7 (Dec 2015) ISSN: 1877-0568 [Electronic] France
• PMID: 26542070 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Chemical References

• Bone Cements

Topics

• Acetabulum (surgery)
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip (adverse effects, instrumentation, methods)
• Bone Cements
• Cohort Studies
• Female
• Follow-Up Studies
• Hip Joint (physiopathology)
• Hip Prosthesis (adverse effects)
• Humans
• Male
• Middle Aged
• Osteoarthritis, Hip (surgery)
• Prosthesis Design
• Prosthesis Failure
• Prosthesis-Related Infections (etiology, surgery)
• Reoperation (methods)
• Retrospective Studies
• Risk
• Risk Factors
• Time Factors