Clinical and radiological outcomes with the Durom™ acetabular cup for large-diameter total hip arthroplasty: 177 implants after a mean of 80 months.

Abstract

BACKGROUND:

Large-diameter metal-on-metal hip prostheses are no longer used, but their outcomes after more than 5 years are unknown. We conducted a retrospective study with a 6.8-year mean follow-up to assess clinical outcomes after Durom™ cup implantation, including the dislocation rate, comparatively to the reference metal-on-polyethylene bearing. We determined the rate of failure ascribable to Durom™ cup use. We also looked for a sharp drop in the implant survival curve during the follow-up period and for factors associated with adverse reactions to metal debris (ARMDs).

HYPOTHESIS:

We hypothesised that clinical outcomes after Durom™ cup implantation were similar to those seen with a metal-on-polyethylene bearing, except for a lower rate of dislocation.

PATIENTS AND METHODS:

We included 177 consecutive THA procedures that were performed between 2005 and 2008 in 165 patients with a mean age of 57.6 ± 9.4 years (range, 31-76 years) and involved the implantation of a Durom™ cup, a femoral head greater than 36mm in diameter, and a PF(®) femoral stem (Zimmer, Etupes, France). The mini-posterior approach was used, with 2mm of acetabular overreaming in 82% of cases, a short femoral neck in 75% of cases, and a mean cup inclination of 34 ± 5° (range, 21-50°).

RESULTS:

Outcomes were assessed for 156 THA procedures in 146 patients after a mean follow-up of 6 years 8 months. The mean Postel-Merle d'Aubigné score improved from 9.7 ± 2.7 (range, 4-14) to 17.4 ± 1.7 (range, 15-18) and the mean Harris hip score from 45.2 ± 15.3 (range, 9-83) to 96.3 ± 7 (75-100). No episodes of dislocation were recorded. We identified 7 failures ascribable to the Durom™ cup including 6 due to ARMD and 1 to aseptic loosening. Implant survival after a mean of 80months was 95.5% (95% CI, 93.1-99.2), with no sharp drop in the survival curve.

CONCLUSION:

The Durom™ cup eliminates the risk of hip dislocation and produces similar functional outcomes to those seen with metal-on-polyethylene bearings after a mean follow-up of 80 months. Nevertheless, given the difficulty in predicting ARMD and hypersensitivity reactions, the Durom™ cup has been discarded and patients carrying it are monitored closely.

• Authors: D Saragaglia, B Belvisi, B Rubens-Duval, R Pailhé, R C Rouchy, R Mader
• Journal: Orthopaedics & traumatology, surgery & research : OTSR (Orthop Traumatol Surg Res) Vol. 101 Issue 4 Pg. 437-41 (Jun 2015) ISSN: 1877-0568 [Electronic] France
• PMID: 25899667 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Chemical References

• Polyethylenes

Topics

• Acetabulum (diagnostic imaging, surgery)
• Adult
• Aged
• Arthroplasty, Replacement, Hip (instrumentation)
• Female
• Femur (diagnostic imaging, surgery)
• Follow-Up Studies
• France
• Hip Dislocation (diagnostic imaging, surgery)
• Hip Prosthesis (statistics & numerical data)
• Humans
• Male
• Middle Aged
• Polyethylenes
• Prosthesis Design
• Radiography
• Retrospective Studies
• Time Factors