Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?
Revision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetab...
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doaj-9b44013d04ae457382a02f5c6cd11f712020-11-25T03:53:19ZengMDPI AGMaterials1996-19442020-04-01132040204010.3390/ma13092040Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option?Saverio Affatato0Emanuela Castiello1Luca Amendola2Saverio Comitini3Jean Louis Prudhon4Domenico Tigani5Laboratorio di Tecnologia Medica, IRCCS – Istituto Ortopedico Rizzoli, 40100 Bologna, ItalyUnità Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, ItalyUnità Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, ItalyUnità Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, ItalyCentre Osteo-Articulaire Echirolles, 38100 Grenoble, FranceUnità Operativa Complessa di Ortopedia e Traumatologia, Ospedale Maggiore, 40100 Bologna, ItalyRevision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetabular component exchange has been proposed in order to limit these complications. Although DM bearing offers an easy solution avoiding the intraoperative and time-associated complications, concern about polyethylene wear and stability remains due to the difference regarding the design, the coverage angle and the clearance of the two implants. In order to evaluate the performance of this new solution with the new material to prevent the possibility of failure it is essential to conduct a review of the literature A qualitative systematic review of the literature has been conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, EMBASE, Google Scholar, and Scopus for English and French articles between January 2000 and October 2019 was performed, with the primary objective of finding articles about dual mobility bearing coupling with large metal-on-metal cup in the case of hip revision procedure. Various combinations of the key words were used in the search strategy. Thirteen articles with DM bearing mated with MoM cup were analyzed. Of the 130 hip revisions selected, with a follow-up from 6 to 53 months, there were a total of 14 with complications (10.77%): four true dislocations (3.08%); six intra-prosthetic dislocations (IPD, 4.6%), two of which presented plastic deformation and polyethylene wear; four other complications (3.08%), included a cup osteolysis, a clicking noise, a superficial infection and a periprosthetic fracture. All the mentioned true dislocations occurred during the first month while IPDs appeared during the first two years from the index revision. In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with large MoM cup cannot be dissolved. It has been pointed out that a DM bearing is not designed for a MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at an even higher rate than they were in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was less optimal than modern ones.https://www.mdpi.com/1996-1944/13/9/2040revisionMoMdual mobilityhiptotal hip arthroplastyoff label use |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Saverio Affatato Emanuela Castiello Luca Amendola Saverio Comitini Jean Louis Prudhon Domenico Tigani |
spellingShingle |
Saverio Affatato Emanuela Castiello Luca Amendola Saverio Comitini Jean Louis Prudhon Domenico Tigani Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? Materials revision MoM dual mobility hip total hip arthroplasty off label use |
author_facet |
Saverio Affatato Emanuela Castiello Luca Amendola Saverio Comitini Jean Louis Prudhon Domenico Tigani |
author_sort |
Saverio Affatato |
title |
Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? |
title_short |
Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? |
title_full |
Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? |
title_fullStr |
Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? |
title_full_unstemmed |
Revision of a Monoblock Metal-on-Metal Cup Using a Dual Mobility Component: Is It a Reasonable Option? |
title_sort |
revision of a monoblock metal-on-metal cup using a dual mobility component: is it a reasonable option? |
publisher |
MDPI AG |
series |
Materials |
issn |
1996-1944 |
publishDate |
2020-04-01 |
description |
Revision of large-diameter, monoblock acetabular components for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA) is correlated to a high amount of complications. For this reason, performing a limited revision by conversion to a dual mobility (DM) without acetabular component exchange has been proposed in order to limit these complications. Although DM bearing offers an easy solution avoiding the intraoperative and time-associated complications, concern about polyethylene wear and stability remains due to the difference regarding the design, the coverage angle and the clearance of the two implants. In order to evaluate the performance of this new solution with the new material to prevent the possibility of failure it is essential to conduct a review of the literature A qualitative systematic review of the literature has been conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed, EMBASE, Google Scholar, and Scopus for English and French articles between January 2000 and October 2019 was performed, with the primary objective of finding articles about dual mobility bearing coupling with large metal-on-metal cup in the case of hip revision procedure. Various combinations of the key words were used in the search strategy. Thirteen articles with DM bearing mated with MoM cup were analyzed. Of the 130 hip revisions selected, with a follow-up from 6 to 53 months, there were a total of 14 with complications (10.77%): four true dislocations (3.08%); six intra-prosthetic dislocations (IPD, 4.6%), two of which presented plastic deformation and polyethylene wear; four other complications (3.08%), included a cup osteolysis, a clicking noise, a superficial infection and a periprosthetic fracture. All the mentioned true dislocations occurred during the first month while IPDs appeared during the first two years from the index revision. In conclusion, according to the literature analyzed, we can stress that the concerns and doubts about mating a DM bearing with large MoM cup cannot be dissolved. It has been pointed out that a DM bearing is not designed for a MoM cup; it is not mechanically tested on MoM cups, which presents different clearance and coverage angles. Predictable complications may occur, such as IPD, polyethylene wear and true dislocation. These complications have been reported at an even higher rate than they were in the eighties, when the first generation of DM implants were of a lower quality of polyethylene and the characteristic of the design was less optimal than modern ones. |
topic |
revision MoM dual mobility hip total hip arthroplasty off label use |
url |
https://www.mdpi.com/1996-1944/13/9/2040 |
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