Late intraprosthetic dislocation of a monoblock dual-mobility cup cemented into a well-fixed cementless acetabular shell. A case report

Late intraprosthetic dislocation of a monoblock dual-mobility cup cemented into a well-fixed cementless acetabular shell. A case report

Authors

  • Maurizio Ulgelmo a:1:{s:5:"en_US";s:33:"Università degli Studi di Verona";}
  • Andrea Sandri Università degli Studi di Verona
  • Dario Regis Università degli Studi di Verona
  • Edoardo Casablanca Università degli Studi di Verona
  • Giovanna Toso Azienda ULSS n. 6 Euganea - Ospedale Civile di Cittadella
  • Roberto Valentini Università degli Studi di Verona
  • Bruno Magnan Università degli Studi di Verona

Keywords:

total hip arthroplasty, revision hip surgery, double socket cup revision technique, cup-in-cup revision technique, dual mobility cup, intraprosthetic dislocation, small articulation dislocation

Abstract

Intraprosthetic dislocation (IPD) is a specific implant-related complication of dual mobility (DM) implants, which is defined as a dissociation of polyethylene (PE) liner from the femoral head.

We report a unique case of  late IPD of a monoblock DM cup cemented into a well-fixed cementless acetabular shell for recurrent dislocation of total hip arthroplasty (THA). A 77-year-old woman was admitted to our department for acute right hip pain, functional impairment and inability to bear weight without any trauma. Three years earlier, she underwent revision THA for recurrent dislocation with a monoblock DM cup cemented into a well-fixed cementless acetabular shell according to the “double-socket” technique. Three months after that revision the patient experienced an anterior THA dislocation, which was managed by closed reduction under sedation in the emergency room. No additional episodes of prosthesis instability occurred.

Upon admission, radiographic evaluation showed  right THA dislocation. X-rays performed  after closed reduction revealed eccentric positioning of the head inside the cup, and a direct contact between the metal head and the cup was revealed by subsequent CT scan, confirming the suspicion of IPD. The patient underwent revision surgery, during which the PE liner was found lodged within the cup in a subluxated position, disassembled from the inner head. Both the acetabular cup and modular femoral stem proved well-fixed and impossible to remove, therefore they were retained. The explanted DM components were replaced with new ones of the same size and, thanks to the femoral neck's modular nature, it was substituted with a longer one, which resulted in improved stability against intraoperative stress maneuvers. The postoperative course was uncomplicated. At 1-year follow-up, the patient had a good functional recovery.

Author Biographies

Maurizio Ulgelmo, a:1:{s:5:"en_US";s:33:"Università degli Studi di Verona";}

Medico in formazione specialistica

Scuola di Specializzazione in Ortopedia e Traumatologia dell’Università degli Studi di Verona

personal email address: [email protected]

Andrea Sandri, Università degli Studi di Verona

Orthopaedic Surgeon

Azienda Ospedaliera Universitaria Integrata Verona

Dario Regis, Università degli Studi di Verona

Orthopaedic Surgeon

Azienda Ospedaliera Universitaria Integrata Verona

Edoardo Casablanca, Università degli Studi di Verona

Medico in formazione specialistica

Scuola di Specializzazione in Ortopedia e Traumatologia dell’Università degli Studi di Verona

Giovanna Toso, Azienda ULSS n. 6 Euganea - Ospedale Civile di Cittadella

Orthopaedic Surgeon

Azienda ULSS n. 6 Euganea - Ospedale civile di Cittadella

Roberto Valentini, Università degli Studi di Verona

Orthopaedic Surgeon

Azienda Ospedaliera Universitaria Integrata Verona

Bruno Magnan, Università degli Studi di Verona

Director, U.O.C. Ortopedia e Traumatologia Azienda Ospedaliera Universitaria Integrata Verona

Professor, University of Verona (Università degli studi di Verona)

Senior Orthopaedic Surgeon

References

Barrack RL. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg 2003; 11(2): 89-99

Bousquet G, Gazielly DF, Debiesse JL. The ceramic coated cementless total hip arthroplasty. Basic concepts and surgical technique. J Orthop Surg Tech 1985; 1(2): 15-28

Jonker RC, van Beers LWAH, van der Wal BCH et al. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2020; 106(3): 509-17

Romagnoli M, Grassi A, Costa et al. The efficacy of dual mobility cup in preventing dislocation after total hip arthroplasty: a systematic review and metaanalysis of comparative studies. Int Orthop 2019; 43(5): 1071-82

Schmidt A, Batailler C, Fary C et al. Dual mobility cups in revision total hip arthroplasty: efficient strategy to decrease dislocation risk. J Arthroplasty 2020; 35(2): 500-7

Brown TS, Tibbo ME, Arsoy D et al. Long-term outcomes of constrained liners cemented into retained, well-fixed acetabular components. J Bone Joint Surg Am 2019; 101(7): 620-7

Wegrzyn J, Thoreson AR, Guyen O et al. Cementation of a dual-mobility acetabular component into a well-fixed metal shell during revision total hip arthroplasty: a biomechanical validation. J Orthop Res 2013; 31(6): 991-7

Lecuire F, Benareau I, Rubini J, Basso M. Intra-prosthetic dislocation of the Bousquet dual mobility socket. Rev Chir Orthop Reparatrice Appar Mot 2004; 90(3): 249-55

Neri T, Boyer B, Geringer J et al. Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring? Int Orthop 2019; 43(5): 1097-1105

Chalmers BP, Ledford CK, Taunton MJ et al. Cementation of a dual mobility construct in recurrently dislocating and high risk patients undergoing revision total arthroplasty. J Arthroplasty 2018; 33(5): 1501-6

Jo S, Jimenez Almonte JH, Sierra RJ. The cumulative risk of re-dislocation after revision THA performed for instability increases close to 35% at 15years. J Arthroplasty 2015; 30(7): 1177-82

Cuthbert R, Wong J, Mitchell P, Kumar Jaiswal P. Dual mobility in primary total hip arthroplasty: current concepts. EFORT Open Rev. 2019 Nov 8;4(11):640-6

Parvizi J, Picinic E, Sharkey PF. Revision total hip arthroplasty for instability: surgical techniques and principles. J Bone Joint Surg Am 2008; 90(5): 1134-42

Beaulé PE, Ebramzadeh E, Le Duff M et al. Cementing a liner into a stable cementless acetabular shell: the double-socket technique. J Bone Joint Surg Am 2004; 86(5): 929-34

Biviji AA, Ezzet KA, Pulido P, Colwell CW Jr. Modular femoral head and liner exchange for the unstable total hip arthroplasty. J Arthroplasty 2009; 24(4): 625-30

de l'Escalopier N, Dumaine V, Auberger G et al. Dual mobility constructs in revision total hip arthroplasty: survivorship analysis in recurrent dislocation versus other indications at three to twelve-year follow-up. Int Orthop 2020; 44(2): 253-60

Pritchett JW. One-component revision of failed hip resurfacing from adverse reaction to metal wear debris. J Arthroplasty 2014; 29(1): 219-24

Kasparek MF, Renner L, Faschingbauer M et al. Salvage of a monoblock metal-on-metal cup using a dual mobility liner: a two-year MRI follow-up study. Int Orthop 2018; 42(5): 1035-41

Philippot R, Boyer B, Farizon F. Intraprosthetic dislocation: a specific complication of the dual mobility system. Clin Orthop Relat Res 2013; 471(3): 965-70

De Martino I, D'Apolito R, Waddell BS et al. Early intraprosthetic dislocation in dual-mobility implants: a systematic review. Arthroplast Today 2017; 3(3): 197-202

Neri T, Philippot R, Farizon F, Boyer B. Results of primary total hip replacement with first generation Bousquet dual mobility socket with more than twenty five years follow up. About a series of two hundred and twelve hips. Int Orthop 2017; 41(3): 557-61

Laurendon L, Philippot R, Neri T et al. Ten-year clinical and radiological outcomes of 100 total hip arthroplasty cases with a modern cementless dual mobility cup. Surg Technol Int 2018; Jun 1: 331-6

Gaillard R, Kenney R, Delalande J-L et al. Ten- to 16-year results of a modern cementless dual-mobility acetabular implant in primary total hip arthroplasty. J Arthroplasty 2019; 34(11): 2704-10

Van Eecke E, Vanbiervliet J, Dauwe J, Mulier M. Comparison of constrained acetabular components and dual mobility cups in revision total hip arthroplasty: a literature review. Hip Pelvis 2020; 32(2): 59-69

Piette N, Guyen O, Moerenhout K. Intra-prosthetic dislocation of dual mobility hip prosthesis: an original and unusual complication. J Radiol Case Rep 2019; 13(5): 15-23

Rotini M, Cianforlini M, Aucone D et al. Iatrogenic intraprosthetic dislocation after closed reduction of dual mobility total hip arthroplasty: Report of two cases. Int J Surg Case Rep 2020; 71: 225-9

Affatato S, Castiello E, Amendola L et al. Revision of a monoblock metal-on-metal cup using a dual mobility component: is it a reasonable option? Materials (Basel). 2020; 13(9): 2040

Guyen O, Pibarot V, Vaz G et al. Use of a dual mobility socket to manage total hip arthroplasty instability. Clin Orthop Relat Res 2009; 467(2): 465-72

Plummer DR, Christy JM, Sporer SM et al. Dual-mobility articulations for patients at high risk for dislocation. J Arthroplasty 2016; 31(9 Suppl): 131-5

Perrin A, Saab M, Putman S et al. The benefit of the systematic revision of the acetabular implant in favor of a dual mobility articulation during the treatment of periprosthetic fractures of the femur: a 49 cases prospective comparative study. Eur J Orthop Surg Traumatol 2018; 28(2): 239-46

Moreta J, Uriarte I, Foruria X et al. Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty. Hip Int. 2021; 31(1): 97-102

Wegrzyn J, Saugy CA, Guyen O, Antoniadis A. Cementation of a dual mobility cup into an existing well-fixed metal shell: a reliable option to manage wear-related recurrent dislocation in patients with high surgical risk. J Arthroplasty 2020; 35(9): 2561-6

Bellova P, Koch F, Stiehler M, Hartmann A, Fritzsche H, Günther KP, Gorornzy J. Cementation of a Dual Mobility Cup in a Well-fixed Acetabular Component- A Reliable Option in Revision Total Hip Arthroplasty? BMC Musculoskelet Disord 2021; Online preprint available at: https://doi.org/10.21203/rs.3.rs-778943/v1

Downloads

Published

21-09-2022

How to Cite

1.
Late intraprosthetic dislocation of a monoblock dual-mobility cup cemented into a well-fixed cementless acetabular shell. A case report. Acta Biomed [Internet]. 2022 Sep. 21 [cited 2024 Jun. 23];93(S1):e2022206. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12553