The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Dual Mobility Cup in Fractures of the Femoral Neck in Neuromuscular Disorders and Cognitive Dysfunction Patients above 60 years-old

Document Type : RESEARCH PAPER

Authors
Mohamed Ahmed El-Deeb
Mahmoud Mabrouk Said
Tharwat Mohamed Abd El-Rahman
Abdel Hamid Abdel Aziz Attalah
Ashraf M. Abdelaziz
Yaser El-Sayed Hassan
Orthopedic department, Faculty of Medicine for Girls ,AlAzhar University, Cairo, Egypt
10.22038/abjs.2023.65924.3157
Abstract
Objectives: Dislocation rate of total hip arthroplasty (THA) can be as high as 20% for patients with
fracture neck of femur, which is a disastrous complication in these vulnerable patients. Numerous
techniques, including bipolar arthroplasty and constrained liner, have been adopted to minimize the
risk of dislocation. We aimed to evaluate the role of dual mobility Cups in treating patients with fractures
of the femoral neck with high risk of postoperative dislocation due to neuromuscular instability
disorders.
Methods: A prospective cohort study was conducted (place is blinded as asked during submission), between 2016
and 2019, with a post-operative follow up period of two years. We included skeletally mature patients with femoral
neck fractures having neuromuscular disorders and cognitive dysfunction who are candidates for THA above 60
years. Patients were then followed up clinically and radiographically at the clinic using Harris Hip Score (HHS) and
x-rays at six weeks, six months, one year and two years postoperatively.
Results: Twenty patients (20 hips) with femoral neck fractures with high risk of postoperative dislocation due to
neuromuscular instability disorders undergoing dual mobility cup were included. The mean age of patients was 70.5
±6.42 years. There is highly significant difference between HHS preoperatively and postoperatively (six weeks, six
months and one, two years) p<0.001.Infection occurred in one case (5 %), sciatic nerve injury occurred in one case
(5%), and none of the patients had postoperative dislocation.
Conclusion: Dual mobility cup is effective in preventing early dislocation in patients suffered from fracture neck of
femur with muscle weakness due to neurologic disorders.
 Level of evidence: IV
Keywords
Dual mobility cup
Fracture neck femur
Neuromuscular instability disorders
Total hip arthroplasty
Subjects
  1. Kakkar R, Kumar S, Singh AK. Cephalomedullary nailing for proximal femoral fractures. Int Orthop. 2005;29(1):21–4.
  2. Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Vannini F, Giannini S. Comparing dynamic hip screw to external fixation for treatment of osteoporotic pertrochanteric fractures: A prospective randomized study. Key Eng Mater. 2005;284–286:1037–40.
  3. Moroni A, Faldini C, Pegreffi F, Hoang-Kim A, Giannini S. Osteoporotic Pertrochanteric Fractures Can Be Successfully Treated with External Fixation. J Bone Jt Surg. 2005;87(suppl_2):42–51.
  4. Mukka SS, Mahmood SS, Sjödén GO, Sayed-Noor AS. Dual mobility cups for preventing early hip arthroplasty dislocation in patients at risk: experience in a county hospital. Orthop Rev (Pavia). 2013;5(2):10.
  5. Prudhon JL, Ferreira A, Verdier R. Dual mobility cup: Dislocation rate and survivorship at ten years of follow-up. Int Orthop. 2013;37(12):2345–50.
  6. Canton G, Moghnie A, Cleva M, Kostoris FM, Murena L. Dual mobility total hip arthroplasty in the treatment of femoral neck fractures: A retrospective evaluation at mid-term follow-up. Acta Biomed. 2019;90:98–103.
  7. Patel PD, Potts A, Froimson MI. The Dislocating Hip Arthroplasty. Prevention and Treatment. J Arthroplasty. 2007;22(4 SUPPL.):86–90.
  8. Zhao F, Ma C, Xiong C. Treatments of dislocation after total hip replacement. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007;21(1):12–4.
  9. Langlais FL, Ropars M, Gaucher F, Musset T, Chaix O. Dual mobility cemented cups have low dislocation rates in THA revisions. In: Clinical Orthopaedics and Related Research. 2008. p. 389–95.
  10. Sanchez-Sotelo J, Haidukewych GJ, Boberg CJ. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Jt Surg - Ser A. 2006;88(2):290–4.
  11. Werner BC, Brown TE. Instability after total hip arthroplasty. World J Orthop. 2012;3(8):122–30.
  12. Vielpeau C, Lebel B, Ardouin L, Burdin G, Lautridou C. The dual mobility socket concept: Experience with 668 cases. Int Orthop. 2011;35(2):225–30.
  13. Mallory TH, Lombardi A V., Fada RA, Herrington SM, Eberle RW. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res. 1999;(358):166–72.
  14. B.P.H. L, D.J. B, W.S. H, F.H. S. Total hip arthroplasty for the treatment of an acute fracture of the femoral neck. J Bone Jt Surg - Ser A [Internet]. 1998;80(1):70–5. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L28087303
  15. P.J. B. Dislocation following total hip replacement: causes and cures. Bone Joint J [Internet]. 2013;95–B(11):67–9. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L604541326
  16. Ries MD. Hip abductor deficiency: What can you do about it? Semin Arthroplasty. 2016;27(1):67–9.
  17. Fackler CD, Poss R. Dislocation in total hip arthroplasties. Clin Orthop Relat Res. 1980;(151):169–78.
  18. Abdelazim H, Michael F. Dual mobility cup for prevention of early total hip arthroplasty dislocation in patients with neurological disorders. Eur Orthop Traumatol. 2015;6(4):427–32.
  19. Ryu HG, Roh YJ, Oh KJ, Hwang JH, Kim Y, Cho HW, et al. Dual mobility articulation total hip arthroplasty for displaced neck fracture in elderly with neuromuscular disorder. Injury [Internet]. 2021;52(6):1480–6. Available from: https://doi.org/10.1016/j.injury.2021.01.005
  20. Zhuang TF, Huan SW, Luo SM, She GR, Wu WR, Chen JY, et al. Outcomes of dual mobility articulation total hip arthroplasty in ipsilateral residual poliomyelitis. Int Orthop [Internet]. 2022;46(3):489–96. Available from: https://doi.org/10.1007/s00264-021-05222-y
  21. Agarwala S, Katariya A, Vijayvargiya M, Shetty V, Swami PM. Superior functional outcome with dual mobility THR as compared to conventional THR in fracture neck femur: A prospective cohort study. Sicot-J. 2021;7.
  22. Combes A, Migaud H, Girard J, Duhamel A, Fessy MH. Low rate of dislocation of dual-mobility cups in primary total hip arthroplasty. In: Clinical Orthopaedics and Related Research. 2013. p. 3891–900.
  23. Guyen O, Pibarot V, Vaz G, Chevillotte C, Carret JP, Bejui-Hugues J. Unconstrained Tripolar Implants for Primary Total Hip Arthroplasty in Patients at Risk for Dislocation. J Arthroplasty. 2007;22(6):849–58.
  24. Boyer B, Philippot R, Geringer J, Farizon F. Primary total hip arthroplasty with dual mobility socket to prevent dislocation: A 22-year follow-up of 240 hips. Int Orthop. 2012;36(3):511–8.
  25. 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(3):619–24.
  26. Philippot R, Neri T, Boyer B, Viard B, Farizon F. Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips. Int Orthop. 2017;41(3):589–94.
  27. Hamadouche M, Arnould H, Bouxin B. Is a cementless dual mobility socket in primary THA A reasonable option? In: Clinical Orthopaedics and Related Research. 2012. p. 3048–53.
  28. Tarasevicius S, Busevicius M, Robertsson O, Wingstrand H. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture. BMC Musculoskelet Disord. 2010;11.
The Archives of Bone and Joint Surgery
Volume 11, Issue 12
December 2023
Pages 757-764

  • Receive Date 10 July 2022
  • Revise Date 08 October 2023
  • Accept Date 30 October 2023