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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 52-54

Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population


1 Department of Orthopaedics, AIIMS Patna, Patna, Bihar, India
2 Department of Orthopaedics, NMCH Patna, Patna, Bihar, India

Date of Submission30-Sep-2019
Date of Decision10-Oct-2019
Date of Acceptance18-Oct-2019
Date of Web Publication23-Dec-2019

Correspondence Address:
Sudeep Kumar
Associate Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Patna - 800 007, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODP.JODP_13_19

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  Abstract 


Purpose: The aim was to evaluate the functional outcome and dislocation rate at a minimum of 1-year follow-up following total hip replacement (THR) using Stryker modular dual mobility (MDM) X3 Mobile Bearing Hip System. Materials and Methods: This was a prospective study. The sample size was twenty patients who had secondary osteoarthritis hip with age <60 years; who had no debilitating disease, neurological motor disease, or any history of hip fracture or infection; and those who had underwent primary uncemented THR. They were evaluated clinically using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Hip Score (OHS) and radiologically using routine radiographs. Results: The mean OHS at a minimum of 1-year follow-up was 40.40 ± 6.253, whereas WOMAC score was 93.85 ± 3.511. Correlational analysis of OHS and WOMAC score revealed very weak relationship (r = 0.165), and P = 0.486 was considered statistically not significant. Conclusion: The present study demonstrates that short-term follow-up of MDM THR is not worse than what is routinely used in the market.

Keywords: Arthroplasty, dislocation, modular dual mobility, young


How to cite this article:
Kumar S, Kumar A, Kumar R. Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population. J Orthop Dis Traumatol 2019;2:52-4

How to cite this URL:
Kumar S, Kumar A, Kumar R. Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population. J Orthop Dis Traumatol [serial online] 2019 [cited 2020 Jan 21];2:52-4. Available from: http://www.jodt.org/text.asp?2019/2/3/52/273882




  Introduction Top


Total hip arthroplasty (THA) is considered one of the most successful surgical procedures providing pain relief and improvement of function in patients with end-stage hip arthritis that is nonresponsive to nonoperative treatments.[1],[2] Burden of hip arthritis is on the rise, and it is estimated that ≥950,000 primary and revision THAs were performed globally in 2010.[3] The outline of patients requiring total hip replacement (THR) is changing with time from the elderly whose activities are limited to household to young patients who aspire to obtain full function as healthy adults. Various sociocultural reasons require squatting and sitting cross-legged [Figure 1] and [Figure 2] whose fulfillment is important for patient's satisfaction, especially in rural India. Surgeons performing replacements are, therefore, presented with a distinctive challenge of fulfilling patient expectations and ensuring magnificent results and at the same time using the most evidence-based and cost-effective implants.
Figure 1: Sitting cross legged

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Figure 2: Squatting position

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Instability is a noteworthy cause of morbidity following THR. Great emphasis is being given to reduce the incidence of medical and mechanical complications after THR. Risk factors for instability after THR are multifactorial and may be patient specific (gender, age, and abductor deficiency) or related to operative variables (surgical approach, component malposition, and femoral head diameter).[4] The incidence of instability after primary and revision replacement has been reported to be as high as 7% and 25%, respectively.[5] The cumulative risk of first-time dislocation is 2% at 1 year and 7% after 15 years of primary hip replacement.[6]

The dual articulation cup was developed by Professor Gilles Bousquet and André Rambert (Engineer) in 1974 and combined the “low-friction” principle of THA popularized by Charnley[7] with the McKee–Farrar concept of using a larger-diameter femoral head to enhance implant stability.[8] The goal was to obtain maximum mobility in stable condition with least wear and tear. The first-generation dual-mobility cups (DMCs) had certain complications such as premature wear of polyethylene (intraprosthetic dislocation), insufficient means of bony fixation, and iliopsoas tendon impingement.[9],[10] However, now, with advancements in the second- and third- generation DMCs' design, they have proven to yield lower mechanical complications when compared to the conventional cups.[11]

We present our short-term series of cases performed in the population whose cultural demand requires sitting on the floor. The aim was to evaluate the functional outcome and dislocation rate at a minimum of 1-year follow-up.


  Materials and Methods Top


This was a prospective study conducted at a government tertiary care hospital in Patna, Bihar, from September 2017 to January 2019. Written informed consent was obtained from all participants. Ethical approval was taken from the institutional ethics committee. The sample size was of twenty patients. Both male and female genders constituted the study population. The age group varied from 17 to 60 years. Inclusion criteria were secondary osteoarthritis hip and a minimum follow-up of 1 year.

Exclusion criteria were the presence of a neurological motor disease, debilitating disease, a history of hip fracture or infection, and age ≥60 years.

Demographic data, etiology, type of approach, type of stem/acetabular cup, bearing surface, and coating were recorded. All patients underwent primary uncemented THR using Stryker Modular Dual Mobility (MDM) X3 Mobile Bearing Hip System.

Surgery was performed in lateral decubitus position using posterior Southern approach to the hip. We used tablet ecosprin 150 mg for postoperative deep-vein thrombosis prophylaxis routinely for 4 weeks. The patients were made to stand and walk with support under the supervision of a physiotherapist from postoperative day (POD) 1 unless and until contraindicated. Drain was used routinely for 24 h. X-rays were taken immediately postoperatively. Sutures were removed on POD 10. Patients were evaluated both clinically and radiologically on their respective follow-up visits. Our scheduled follow-ups were at 6 weeks, 3 months, 6 months, and at 1 year and thereafter, at 6-month interval. During the follow-up:

  1. Routine X-ray pelvis with both hips in anteroposterior and cross-table lateral views was taken to assess for cup migration, progressive radiolucencies, or positional changes in the cup or stem
  2. Clinical assessment was done using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Oxford Hip Score (OHS)
  3. Assessment and analysis of any complications were observed.


No patient was lost to follow-up.

Statistical analysis was done using SPSS software SPSS software (SPSS Inc., Chicago, United states). The mean of continuous variables and P value were calculated. In order to study associations between two continuous variables, a Pearson's correlation coefficient was calculated. Differences were considered to be of statistical significance at P < 0.05 and highly significant at P < 0.001.


  Results Top


Eighty percent (n = 16) of the patient population comprised males [Table 1]. It reflected the general population which visits our outpatient department. The mean age of the study group was 37.95 (17–60) years. Sixty percent (n = 12) of the patients had pathology in the right hip, whereas 40% (n = 8) had left hip involvement [Table 2]. None of the patients had bilateral hip involvement. Indications for THR were as follows: 14 (70%) osteonecrosis, three (15%) Perthes hip, and three (15%) failed aseptic bipolar prosthesis. Radiological assessment did not reveal any sign of stem failure, acetabular failure, femoral fracture, or heterotopic ossification.
Table 1: Gender distribution

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Table 2: Side distribution

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The mean OHS at a minimum of 1-year follow-up was 40.40 ± 6.253, whereas WOMAC score was 93.85 ± 3.511. Correlational analysis of OHS and WOMAC score revealed very weak relationship (r = 0.165), and P = 0.486 was statistically not significant [Table 3]. No patients in the series had a dislocation. One patient had delayed wound healing.
Table 3: Correlational analysis between Western Ontario and McMaster Universities Arthritis Index and Oxford Hip Score

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  Discussion Top


Dual-mobility articulations may help decrease instability after THA.[4],[12],[13] This may be attributed to the increased effective size of the femoral head as well as the expanded impingement-free range of motion. Primary indications of DMC are patients at higher risk of dislocation such as those with neuromuscular diseases; patients older than 75 years; and those with a history of prior hip surgery, revision surgery, and primary THA after femoral neck fracture or after tumor resection.[14] Literature has limited reports of the role of MDM in young active patients, and this subset of a population definitely are at high risk of dislocation and more prone to wear and osteolysis. Epinette et al.,[15] Puch et al.,[16] and Assi et al.[17] reported the outcome of MDM in young population, and they confronted no dislocation and intraprosthetic dislocation of mechanical cup failure.

Our study had excellent mean WOMAC and OHSs at a minimum of 1-year follow-up. Following primary THR, the incidence of dislocation was highest in the 1st year, and our study had no case of dislocation. None of the patients in our study group had infection or mechanical loosening at the last follow-up. Certain problems such as osteolysis may arise later as it could not be detected with a short-term study.

This study has some limitations which have to be pointed out as follows:

  1. Small sample size
  2. Short-term follow-up.



  Conclusion Top


The present study demonstrates that short-term follow-up of MDM THR is not worse than what is routinely used in the market. The DMC appears to be a safe surgical option where squatting or sitting cross-legged on the floor is one of the functional prerequisites, especially in rural population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Austin MS, Higuera CA, Rothman RH. Total hip arthroplasty at the Rothman Institute. HSS J 2012;8:146-50.  Back to cited text no. 1
    
2.
NIH consensus conference: Total hip replacement. NIH consensus development panel on total hip replacement. JAMA 1995;273:1950-6.  Back to cited text no. 2
    
3.
Kurtz SM, Röder C, Lau E, Ong K, Widmer M, Maravic M, et al. International Survey of Primary and Revision Total Hip Replacement. 56th Annual Meeting of the Orthopaedic Research Society; 2010.  Back to cited text no. 3
    
4.
Prudhon JL, Ferreira A, Verdier R. Dual mobility cup: Dislocation rate and survivorship at ten years of follow-up. Int Orthop 2013;37:2345-50.  Back to cited text no. 4
    
5.
Patel PD, Potts A, Froimson MI. The dislocating hip arthroplasty: Prevention and treatment. J Arthroplasty 2007;22:86-90.  Back to cited text no. 5
    
6.
Berry DJ, von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty. J Bone Joint Surg Am 2004;86:9-14.  Back to cited text no. 6
    
7.
Charnley J. The long-term results of low-friction arthroplasty of the hip performed as a primary intervention. J Bone Joint Surg Br 1972;54:61-76.  Back to cited text no. 7
    
8.
McKee GK, Watson-Farrar J. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br 1966;48:245-59.  Back to cited text no. 8
    
9.
Philippot R, Farizon F, Camilleri JP, Boyer B, Derhi G, Bonnan J, et al. Survival of cementless dual mobility socket with a mean 17 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 2008;94:e23-7.  Back to cited text no. 9
    
10.
Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C. The dual mobility socket concept: Experience with 668 cases. Int Orthop 2011;35:225-30.  Back to cited text no. 10
    
11.
Fessy MH. Dual mobility: A Stéphanois concept (St Etienne area, France). Maitrise Orthop 2006;152.  Back to cited text no. 11
    
12.
Epinette JA. Clinical outcomes, survivorship and adverse events with mobile-bearings versus fixed-bearings in hip arthroplasty-a prospective comparative cohort study of 143 ADM versus 130 trident cups at 2 to 6-year follow-up. J Arthroplasty 2015;30:241-8.  Back to cited text no. 12
    
13.
Mohammed R, Hayward K, Mulay S, Bindi F, Wallace M. Outcomes of dual-mobility acetabular cup for instability in primary and revision total hip arthroplasty. J Orthop Traumatol 2015;16:9-13.  Back to cited text no. 13
    
14.
De Martino I, Triantafyllopoulos GK, Sculco PK, Sculco TP. Dual mobility cups in total hip arthroplasty. World J Orthop 2014;5:180-7.  Back to cited text no. 14
    
15.
Epinette JA, Béracassat R, Tracol P, Pagazani G, Vandenbussche E. Are modern dual mobility cups a valuable option in reducing instability after primary hip arthroplasty, even in younger patients? J Arthroplasty 2014;29:1323-8.  Back to cited text no. 15
    
16.
Puch JM, Derhi G, Descamps L, Verdier R, Caton JH. Dual-mobility cup in total hip arthroplasty in patients less than fifty five years and over ten years of follow-up: A prospective and comparative series. Int Orthop 2017;41:475-80.  Back to cited text no. 16
    
17.
Assi C, El-Najjar E, Samaha C, Yammine K. Outcomes of dual mobility cups in a young Middle Eastern population and its influence on life style. Int Orthop 2017;41:619-24.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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