title: Clinical and radiological outcomes with the Durom™ acetabular cup for large-diameter total hip arthroplasty: 177 implants after a mean of 80 months.
abstract: BACKGROUND
  Large-diameter metal-on-metal hip prostheses are no longer used, but their outcomes after more than 5 years are unknown. We conducted a retrospective study with a 6.8-year mean follow-up to assess clinical outcomes after Durom™ cup implantation, including the dislocation rate, comparatively to the reference metal-on-polyethylene bearing. We determined the rate of failure ascribable to Durom™ cup use. We also looked for a sharp drop in the implant survival curve during the follow-up period and for factors associated with adverse reactions to metal debris (ARMDs).
  
  
  OBJECTIVE
  We hypothesised that clinical outcomes after Durom™ cup implantation were similar to those seen with a metal-on-polyethylene bearing, except for a lower rate of dislocation.
  
  
  METHODS
  We included 177 consecutive THA procedures that were performed between 2005 and 2008 in 165 patients with a mean age of 57.6 ± 9.4 years (range, 31-76 years) and involved the implantation of a Durom™ cup, a femoral head greater than 36mm in diameter, and a PF(®) femoral stem (Zimmer, Etupes, France). The mini-posterior approach was used, with 2mm of acetabular overreaming in 82% of cases, a short femoral neck in 75% of cases, and a mean cup inclination of 34 ± 5° (range, 21-50°).
  
  
  RESULTS
  Outcomes were assessed for 156 THA procedures in 146 patients after a mean follow-up of 6 years 8 months. The mean Postel-Merle d'Aubigné score improved from 9.7 ± 2.7 (range, 4-14) to 17.4 ± 1.7 (range, 15-18) and the mean Harris hip score from 45.2 ± 15.3 (range, 9-83) to 96.3 ± 7 (75-100). No episodes of dislocation were recorded. We identified 7 failures ascribable to the Durom™ cup including 6 due to ARMD and 1 to aseptic loosening. Implant survival after a mean of 80months was 95.5% (95% CI, 93.1-99.2), with no sharp drop in the survival curve.
  
  
  CONCLUSIONS
  The Durom™ cup eliminates the risk of hip dislocation and produces similar functional outcomes to those seen with metal-on-polyethylene bearings after a mean follow-up of 80 months. Nevertheless, given the difficulty in predicting ARMD and hypersensitivity reactions, the Durom™ cup has been discarded and patients carrying it are monitored closely.
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France. Electronic address: DSaragaglia@chu-grenoble.fr.
authors.forename: D
authors.initials: D
authors.lastname: Saragaglia
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
authors.forename: B
authors.initials: B
authors.lastname: Belvisi
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
authors.forename: B
authors.initials: B
authors.lastname: Rubens-Duval
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
authors.forename: R
authors.initials: R
authors.lastname: Pailhé
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
authors.forename: R C
authors.initials: RC
authors.lastname: Rouchy
authors.affiliation: Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, BP 338, 38130 Échirolles, France.
authors.forename: R
authors.initials: R
authors.lastname: Mader
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005602:France; D006617:Hip Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011095:Polyethylenes; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D011095:Polyethylenes
keywords: Durom™; Large-diameter head; Metal-on-metal; Total hip arthroplasty