Dual mobility components for THA may be justified in high-risk patients
Click Here to Manage Email Alerts
Key takeaways:
- Dual mobility components are linked to decreased dislocation rate, according to a presenter.
- Utilization of dual mobility components was more than 12% in recent American Joint Replacement Registry data.
KOLOA, Hawaii — Dual mobility components in total hip arthroplasty are a proven concept that decrease dislocation rates in patients at high risk for instability, according to a presenter here.
“[Dual mobility] is now highly popular worldwide,” Rafael J. Sierra, MD, orthopedic surgeon at the Mayo Clinic, said in his presentation at Orthopedics Today Hawaii. “I do not use them routinely for primary total hip arthroplasty, but I do feel that they are justified in high-risk patients, independent of your approach.”
According to Sierra, in primary hip arthroplasty, the utilization of dual mobility components was more than 12% in recent American Joint Replacement Registry data.
“We know that if we do have a dislocation and a patient requires a revision, the risk of that patient needing a subsequent revision is up to 35% at 15 years,” Sierra said. “Clearly prevention is better than treatment, and that is independent of surgical approach. Even though you do anterior-based approaches, thinking about occasional use of dual mobility is important.”
In addition, Sierra said surgeons should have a thoughtful approach to patients who are at high risk for instability, which include patients with connective tissue disorder, a surgical diagnosis other than osteoarthritis, major spine issues, neurologic conditions, as well as female and older patients.
He said his indications for dual mobility components include older patients with normal range of motion; patients undergoing primary THA for a displaced femoral neck fracture; patients with neurologic dysfunction, spasticity, tremor or Parkinson’s disease; patients who underwent a contralateral primary THA and have a dislocation; and patients with multilevel surgical or biologic fusions.
However, Sierra noted that dual mobility components have some disadvantages and potential complications.
“Intraprosthetic dissociation is unique to dual mobility use and always requires a revision,” Sierra said. “There are some compromises in fixation if you plan to use a monoblock dual mobility. There are some concerns about wear and obviously higher costs of these bearings. If you use a modular dual mobility, that is where you are putting in a metal liner into a titanium shell, then there are some current concerns for corrosion long term that you need to be aware of.”
He concluded, “Even though we have now improved our surgical technique and we are using larger diameter heads, I do think that dual mobility has added an effective weapon to our armamentarium.”
Collapse
Sierra RJ. Best use of dual mobility components. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2025; Koloa, Hawaii.
Click Here to Manage Email Alerts