Titre
The use of dual mobility cups in revision total hip arthroplasty for failed large head metal-on-metal bearings
Type
thèse de doctorat
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Auteur(s)
Meriem, Samir
Auteure/Auteur
Directrices/directeurs
Wegrzyn, Julien
Directeur⸱rice
Liens vers les personnes
Liens vers les unités
Faculté
Université de Lausanne, Faculté de biologie et médecine
Statut éditorial
Accepté
Date de publication
2024
Langue
anglais
Résumé
Purpose Revision of failed large head metal-on-metal (MoM) total hip arthroplasty (THA) is a challenging procedure par- ticularly to reconstruct acetabular bone defect due to osteolysis and to achieve hip stability due to soft tissue damages, both potentially caused by adverse reaction to metal debris (ARMD). This study aimed to evaluate the outcome of dual mobility cup (DMC) constructs in revision THA for failed large head MoM bearings with a special attention to the occurrence of dislocation or re-revision.
Methods Between 2015 and 2019, 57 patients (64 THAs, 41 men, mean age = 65 ± 10 years) underwent revision for MoM THA with the use of DMC were prospectively included in our total joint registry. Mean time to revision was 11 ± 2.5 years. The causes for revision were adverse reaction to metal debris (ARMD) in 49 THAs (76%), painful hip with elevated blood cobalt-chromium ions in seven (11%), and acetabular aseptic loosening in eight (13%). The revision was complete in 22 THAs (34%) and acetabular only in 42 (66%). Clinical and radiographic outcomes, complications, and re-revisions were evaluated at most recent follow-up.
Results At mean follow-up of six ± 1.5 years, the pre- to postoperative Harris Hip Score improved from 74 ± 19 to 92 ± 4 (p = 0.004). Complications occurred in 11 cases (17%): five dislocations (8%), three periprosthetic infections (5%), two aseptic loosening of the acetabular component (3%), and two periprosthetic fractures (3%). Re-revision was required in six cases (9%).
Conclusion The use of DMC is a reliable option to prevent instability and ensure a stable acetabular reconstruction in revi- sion THA for failed large head MoM bearings. However, dislocation after revision remains a concern, particularly in cases of severe soft tissue damage related to ARMD.
Methods Between 2015 and 2019, 57 patients (64 THAs, 41 men, mean age = 65 ± 10 years) underwent revision for MoM THA with the use of DMC were prospectively included in our total joint registry. Mean time to revision was 11 ± 2.5 years. The causes for revision were adverse reaction to metal debris (ARMD) in 49 THAs (76%), painful hip with elevated blood cobalt-chromium ions in seven (11%), and acetabular aseptic loosening in eight (13%). The revision was complete in 22 THAs (34%) and acetabular only in 42 (66%). Clinical and radiographic outcomes, complications, and re-revisions were evaluated at most recent follow-up.
Results At mean follow-up of six ± 1.5 years, the pre- to postoperative Harris Hip Score improved from 74 ± 19 to 92 ± 4 (p = 0.004). Complications occurred in 11 cases (17%): five dislocations (8%), three periprosthetic infections (5%), two aseptic loosening of the acetabular component (3%), and two periprosthetic fractures (3%). Re-revision was required in six cases (9%).
Conclusion The use of DMC is a reliable option to prevent instability and ensure a stable acetabular reconstruction in revi- sion THA for failed large head MoM bearings. However, dislocation after revision remains a concern, particularly in cases of severe soft tissue damage related to ARMD.
PID Serval
serval:BIB_C0A32D5E33CD
Date de création
2024-06-10T09:26:01.169Z
Date de création dans IRIS
2025-05-21T01:18:36Z
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Nom
these-MS-OK.pdf
Version du manuscrit
imprimatur
Taille
1.03 MB
Format
Adobe PDF
PID Serval
serval:BIB_C0A32D5E33CD.P001
URN
urn:nbn:ch:serval-BIB_C0A32D5E33CD1
Somme de contrôle
(MD5):0650ae0f459866120ce77f2db60e3c5a