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Enhanced THA planning may achieve better hip stability than dual-mobility prostheses
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ORLANDO — Despite the increased use of dual-mobility hip designs in the United States and their solid track record of use in Europe, a presenter discussed concerns he has about possibly increased rates of dislocation and wear with dual-mobility hip prostheses and the reported risk of corrosion among modular version of these designs.
“We know instability is a problem and we know it represents a big burden in the revision realm, and we’re certainly concerned. We know at this point there’s lots of factors associated with instability: patient factors, surgeon factors, implant factors,” Douglas E. Padgett, MD, said at the Current Concepts in Joint Replacement Winter Meeting.
However, in the urgency to avoid instability in our patients, “what we’ve done is we’ve over-reacted. The tendency is to constraint, and I think that is wrong,” he said.
“In my summation, dual-mobility is a rarely needed solution,” Padgett said.
In his presentation, Padgett said that instead of relying on a dual-mobility prosthesis to resolve the problem of patients who dislocate primarily or recurrently, total joint replacement surgeons should do a more robust preoperative evaluation of the patient.
He called this “the era of enhanced planning,” which includes obtaining more information about a patient’s hip position during sitting and other activities and implanting hip prostheses that are more accurately positioned.
“Do you need a robot or navigation? Your call, but adjust your cup accordingly,” Padgett said. – by Susan M. Rapp
Reference:
Padgett DE. Paper 23. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-15, 2018; Orlando.
Disclosure: Padgett reports he receives consulting fees for product development from DJO.