Speaker cites expanded indications for dual mobility hip articulations
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WAILEA, Hawaii — Despite some concerns he has, a presenter at Orthopedics Today Hawaii recommended dual mobility total hip replacement for its ability to reduce hip dislocation in certain high-risk primary and revision THR patients.
Christopher L. Peters, MD, said, in general, dual mobility and tripolar THR articulations are gaining in popularity.
“Dual mobility constructs in primaries and revisions [are] highly effective at reducing dislocation. Now, there are some concerns,” he said.
Although generally in support of dual mobility THR systems when properly indicated, Peters cited case reports and “extremely low” reported rates in the literature that he deemed “acceptable” of liner malseating, intraprosthetic dislocation, corrosion and potential ion release with these articulations.
“I think the evidence for their efficacy far outweighs the small concerns for ion problems at this point in time and so, I think [the systems are] highly recommended for the high-risk primary dislocation patient and the high-risk revision patient,” he said.
Indications for dual mobility primary THR prostheses are patients with a high risk of dislocation, with neuromuscular or connective tissue disorders, or with a stiff spine.
Patients with small anatomy are also indicated for dual mobility THR, such as women who need a cup size that is less than 50 mm “and our poly options are limited to 28 [mm] or 32 [mm] in those 40-[mm] to 48-mm sockets,” Peters said.
“Conversely, large anatomy – when we have size 60 [mm] and above cups – when we use a 36 [mm] or lower articulation – we have a lot of dead space, and potentially keeping a femoral design that matches closer to the patient’s femoral head is advantageous,” he said.
Additional indications include patients with a femoral neck fracture being operated on through a posterior approach and patients undergoing conversion from prior hip surgery, according to Peters.
Regarding dual mobility constructs for revision THR, Peters said, “Any revision, I think, now becomes a relative indication for use of a dual mobility. Fracture cases, periprosthetic fracture cases, secondary [periprosthetic joint infection] PJI cases, when we’re going back in at the second stage, I think is a good indication, and some abductor deficiency cases, if our implants are in good position, I think are good indications for dual mobility.”
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Peters CL. Indications for a dual mobility articulation. Presented at: Orthopedics Today Hawaii 2021; May 30-June 3, 2021; Wailea, Hawaii.
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