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Dual mobility cups (6)
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Transcript of Dual mobility cups (6)
DUAL MOBILITY CUPS – KHOULA EXPERIENCE
Dr. Jatinder S. Luthra MS, DNB, MRCS
Dr. Amur Riyami
Dr. Mohamad Kasim Allami FRCS , FRCS ( Trauma & Ortho)
• THR – 1.5 million worldwide
• One of most succesfulprocedure
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
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 arthroplastyBerry et al JBJS 2004
Surgical Factors
Implant Factors
Patient Factors
Impingement
Jump Distance Reduction
Dual Mobility - Concept
• Gilles Bosquet and Raoul Lambart - 1975
Based on
• Low friction arthroplasty ( Charnley)
• Low dislocation rate – Large Femoral Head (Mackee Farrar)
• Larger femoral head reduced dislocation
- Better head neck ratio – better movement
- Greater translocation is required before dislocation
• 3 components & 3 joints
• - Acetabular socket (cemented / cementless)
• Poly Liner
• Metal / Ceramic head
• Liner is free in acetabularcomponent
• Small Joint – Poly liner & head
• Large joint – Poly liner metal cup
Recruitment Phenomenon
Indications
• > 65 yrs
• Prior Hip Surgery
• Neuromuscular disease
• Cognitive Dysfunction
• ASA > 3
• Revision THR
Khoula Experience
• Early results
• Mar 2011 – Till Date
• 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
Total Case - 47
PrimaryTHR
RevisionTHR
22 27
Total Cases 47
PrimaryTHR 22
RevisionTHR 25
Primary THR
127
21
Primary THR 22
OA
# Neck femur
# Acetabulum
Sickler
Osteoarthritis - 12
# Neck Femur – 7
# Acetabulum – 2
Sickler - 1
Revision THR
5
93
2
4
2
Revision THR 25
Failed DHS
Failed Hemi
Infection
Periprostheticfracture
Revision THR
Failedosteosynthesi
Failed DHS - 5
Failed Hemi - 9
Infection - 3
Periprostheticfracture - 2
Revision THR - 4
Failed Osteosynthesis - 2
• Posterior approach
• Avantage Privelege Cup system ( Biomet)
• Patients with high risk of post op dislocation
Acetabular Size
Size 44 - 25
Size 46 – 10
Size 48 – 5
Size 50 - 4
Size 52 - 3
25
10
54
3
0
5
10
15
20
25
30
44 46 48 50 52
Acetabular Sizes
AcetabularSizes
Femoral Sizes
8
26
10
21
0
5
10
15
20
25
30
7 9 11 13 15
Axi
s Ti
tle
Axis Title
Femoral sizes
Femoral sizes
Size 7 - 8
Size 9 - 26
Size 11 - 10
Size 13 - 2
Size 15 - 1
0
5
10
15
20
25
30
35
40
No Of Cases
No Of Cases
Cemented – 36 (76%)
Uncemented - 2 (4%)
Hybrid – 9 ( 19%)
Fluoroscopic evaluation
• 7 pt agreed in follow up to undergo fluoroscopic evaluation
• No impingement at extremes of movement
Fluoroscopic evaluation
Complications
• Deep infection – 1
• Dislocation – 1
• Mortality – 1
• Intraop Fracture - 2
Results
• Follow up range from 4mths to 42mths
• Good early Results in high risk cases in Omani population
• Dislocation - 2% ( Revision THR)
Radiological Evaluation
• No reported cases of osteolysis
• No signs of aseptic loosening
• Fluoroscopy demonstrates – no impingement
Dual mobility cup - Sickler
Dual mobility cup – Failed Osteosynthesis
Dual mobility cup - # Neck Femur
Dual mobility cup – Failed DHS
Dual mobility cup – Failed Hemi
Dual mobility cup - Arthritis
Dual mobility cup – Post Infection
Dual mobility cup – Old Acetab. #
Dual mobility cup – Revision THR
Intraprosthetic dislocation
Concern about early Intraprosthetic Dislocation in Dual Mobility ImplantsMarc et Al JBJS Case Connector 2013
Femoral head dislodgement complicating use of a Dual Mobility Prosthesis for recurrent InstabilityBanzhof et al Journal of Arthroplasty 2010
Severe Metallosis owing to intraprosthetic dislocation in a failed Dual – mobility cup Primary Total Hip ArthroplastyMohammad et al Journal of Arthroplasty 2011
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
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
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
Dual Mobility cup in Revision THR
• Dislocation after conventional THR –dislocation 5% to 30 %
Muscular insufficiency
Bone loss Aggressive capsulectomy
Difficulty in implant positioning
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
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
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
Dual mobility cup in spastic disorder
• Dislocation rate – 14 %
• Sanders et al – 10 hips – no dislocation – 3 yrs
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
THANK YOU