Is a cementless dual mobility socket in primary THA a reasonable option?
BACKGROUND
Dislocation after THA continues to be relatively common. Dual mobility sockets have been associated with low dislocation rates, but it remains unclear whether their use in primary THA would not introduce additional complications.


OBJECTIVE
We therefore asked whether a current cementless dual mobility socket (1) reduced the dislocation rate after primary THA, (2) provided a pain-free and mobile hip, and (3) provided durable radiographic fixation of the acetabular component without any unique modes of failure.


METHODS
We retrospectively reviewed 168 patients who underwent primary THA using a dual mobility socket between January 2000 and June 2002. The average age at surgery was 67 years. We assessed the rate of dislocation, hip function, and acetabular fixation on serial radiographs. Of the 168 patients, 119 (71%) had clinical and radiographic evaluation at a minimum of 5 years (mean, 6 years; range, 5-8 years).


RESULTS
A long-neck option left the base of the Morse taper uncovered in 53 hips. Four patients underwent revision for dislocation between the femoral head and the mobile insert (intraprosthetic dislocation) at a mean 6 years; all four revisions occurred among the 53 hips with an incompletely covered Morse taper.


CONCLUSIONS
A current cementless dual mobility socket was associated with a pain-free and mobile hip and durable acetabular fixation without dislocations if the long-neck option was not used. However, intraprosthetic dislocation related to contact at the femoral neck to mobile insert articulation required revision in four hips. Surgeons should be aware of this specific complication.


METHODS
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Center, Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, 27 Rue du Faubourg St Jacques, 75014 Paris, France. moussah@club-internet.fr
Moussa
M
Hamadouche
Hervé
H
Arnould
Bertrand
B
Bouxin
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
D001843:Bone Cements