Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?

Abstract Background The “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” techn...

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Autores principales:	Petri Bellova, Fiona Koch, Maik Stiehler, Albrecht Hartmann, Hagen Fritzsche, Klaus-Peter Günther, Jens Goronzy
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Dual mobility cup “Cup-in-cup” Double socket Total hip arthroplasty Revision Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/5489f9b80dc94db3b18b9fb8c5a7817e
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spelling	oai:doaj.org-article:5489f9b80dc94db3b18b9fb8c5a7817e2021-11-28T12:24:30ZCementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?10.1186/s12891-021-04835-z1471-2474https://doaj.org/article/5489f9b80dc94db3b18b9fb8c5a7817e2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04835-zhttps://doaj.org/toc/1471-2474Abstract Background The “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery. Methods From 2015 to 2020, 33 patients treated with the DMC- “cup in cup” technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method. Results The mean age at surgery was 78.6 ± 7.1 (63–93) years and the mean surgery duration was 124.4 ± 52.0 (60–245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration (n = 19) was 28.5 ± 17.3 (3–64) months. The mean HHS score at FU was 59.4 ± 22.2 (29–91) and the mean WOMAC score was 59.7 ± 25.6 (15.6–93.8). Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5–64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5–64.7) months. Conclusions We found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.Petri BellovaFiona KochMaik StiehlerAlbrecht HartmannHagen FritzscheKlaus-Peter GüntherJens GoronzyBMCarticleDual mobility cup“Cup-in-cup”Double socketTotal hip arthroplastyRevisionDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Dual mobility cup “Cup-in-cup” Double socket Total hip arthroplasty Revision Diseases of the musculoskeletal system RC925-935
spellingShingle	Dual mobility cup “Cup-in-cup” Double socket Total hip arthroplasty Revision Diseases of the musculoskeletal system RC925-935 Petri Bellova Fiona Koch Maik Stiehler Albrecht Hartmann Hagen Fritzsche Klaus-Peter Günther Jens Goronzy Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
description	Abstract Background The “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery. Methods From 2015 to 2020, 33 patients treated with the DMC- “cup in cup” technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method. Results The mean age at surgery was 78.6 ± 7.1 (63–93) years and the mean surgery duration was 124.4 ± 52.0 (60–245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration (n = 19) was 28.5 ± 17.3 (3–64) months. The mean HHS score at FU was 59.4 ± 22.2 (29–91) and the mean WOMAC score was 59.7 ± 25.6 (15.6–93.8). Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5–64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5–64.7) months. Conclusions We found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.
format	article
author	Petri Bellova Fiona Koch Maik Stiehler Albrecht Hartmann Hagen Fritzsche Klaus-Peter Günther Jens Goronzy
author_facet	Petri Bellova Fiona Koch Maik Stiehler Albrecht Hartmann Hagen Fritzsche Klaus-Peter Günther Jens Goronzy
author_sort	Petri Bellova
title	Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
title_short	Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
title_full	Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
title_fullStr	Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
title_full_unstemmed	Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
title_sort	cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
publisher	BMC
publishDate	2021
url	https://doaj.org/article/5489f9b80dc94db3b18b9fb8c5a7817e
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Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?

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