Otto Aufranc Award: Dual-mobility Constructs in Revision THA Reduced Dislocation, Rerevision, and Reoperation Compared with Large Femoral Heads

Molly A. Hartzler, Matthew Abdel, Peter K. Sculco, Michael J. Taunton, Mark Pagnano, Arlen D. Hanssen

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background Dislocation is one of the most common complications after revision THA. Dual-mobility constructs and large femoral heads (ie, 40 mm) are two contemporary, nonconstrained bearing options used in revision THA to minimize the risk of dislocation; however, it is not currently established if there is a clear benefit to using dualmobility constructs over large femoral heads in the revision setting. Questions/purposes We sought to determine if dual-mobility constructs would provide a reduction in dislocation, rerevision for dislocation, and reoperation or other complications as compared with large femoral heads in revision THA. Methods From 2011 to 2014, a series of 355 THAs underwent revision for any reason and received either a dualmobility construct (146 THAs) or a 40-mm large femoral head (209 THAs). Indications for either construct were based on surgeon judgment; however, there is a preference to use dual-mobility constructs in patients believed to be at higher risk of dislocation. In the dual-mobility group, 20 of 146 (14%) were excluded because of loss of followup before 2 years or because they had a dual-mobility shell cemented into a preexisting acetabular component. In the large head group, 33 of 209 (16%) were lost to followup before 2 years. Followup in the dual-mobility group was 3.3 6 0.8 years and followup in the large head groupwas 3.9 6 0.9 years. Primary endpoints included dislocation, rerevisions for dislocation, and reoperations, which were determined through our institution's total joint registry and verified by individual patient chart review. Age and body mass index were not different with the numbers available between the groups, but there was a slight predominance of females in the dual-mobility group (52% [66 of 126] female) versus the 40-mm large head group (41% [72 of 176] female) (p = 0.05). Notably, 33% (41 of 126) of patients receiving the dual-mobility constructs had the index revision THA done for a diagnosis of recurrent dislocation versus 9% (17 of 176) in the 40-mm large head group. Mean effective head size in the dual-mobility group was 47 mm (range, 38-58 mm). Results The subsequent frequency of dislocation in the dual-mobility construct group was less (3% [four of 126] dual-mobility versus 10% [17 of 176] in the 40-mm large head group; hazard ratio, 3.2 [1.1-9.4]; p = 0.03). Rerevision for dislocation in the dual-mobility construct group was less frequent (1% [one of 126] dualmobility versus 6% [10 of 176] in the 40-mm large head group; hazard ratio, 7.1 [0.9-55.6]; p = 0.03). Reoperation for any cause in the dual-mobility construct group was less frequent (6% [eight of 126] dual-mobility versus 15% [27 of 176] in the 40-mm large head group; hazard ratio, 2.5 [1.1-5.5]; p = 0.02); there were no differences between the groups in terms of the overall percentage of complications in each group. Conclusions When compared with patients treated with a 40-mm large femoral head, patients undergoing revision THA who received a dualmobility construct had a lower risk of subsequent dislocation, rerevision for dislocation, and reoperation for any reason in the first several years postoperatively. Those findings were present despite selection bias in this study to use the dual-mobility construct in patients at the highest risk for subsequent dislocation. Given the lower risk of subsequent dislocation, rerevision, and reoperation with the dual-mobility construct, some surgeons may wish to consider whether the role of dual-mobility should be judiciously expanded in contemporary revision THA.

Original languageEnglish (US)
Pages (from-to)293-301
Number of pages9
JournalClinical orthopaedics and related research
Volume476
Issue number2
DOIs
StatePublished - Feb 1 2018

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Tacrine
Thigh
Reoperation
Selection Bias
Registries
Body Mass Index
Joints
Head

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Otto Aufranc Award : Dual-mobility Constructs in Revision THA Reduced Dislocation, Rerevision, and Reoperation Compared with Large Femoral Heads. / Hartzler, Molly A.; Abdel, Matthew; Sculco, Peter K.; Taunton, Michael J.; Pagnano, Mark; Hanssen, Arlen D.

In: Clinical orthopaedics and related research, Vol. 476, No. 2, 01.02.2018, p. 293-301.

Research output: Contribution to journalArticle

@article{bd4a531d721b4b5b9c955a67e843d0c3,
title = "Otto Aufranc Award: Dual-mobility Constructs in Revision THA Reduced Dislocation, Rerevision, and Reoperation Compared with Large Femoral Heads",
abstract = "Background Dislocation is one of the most common complications after revision THA. Dual-mobility constructs and large femoral heads (ie, 40 mm) are two contemporary, nonconstrained bearing options used in revision THA to minimize the risk of dislocation; however, it is not currently established if there is a clear benefit to using dualmobility constructs over large femoral heads in the revision setting. Questions/purposes We sought to determine if dual-mobility constructs would provide a reduction in dislocation, rerevision for dislocation, and reoperation or other complications as compared with large femoral heads in revision THA. Methods From 2011 to 2014, a series of 355 THAs underwent revision for any reason and received either a dualmobility construct (146 THAs) or a 40-mm large femoral head (209 THAs). Indications for either construct were based on surgeon judgment; however, there is a preference to use dual-mobility constructs in patients believed to be at higher risk of dislocation. In the dual-mobility group, 20 of 146 (14{\%}) were excluded because of loss of followup before 2 years or because they had a dual-mobility shell cemented into a preexisting acetabular component. In the large head group, 33 of 209 (16{\%}) were lost to followup before 2 years. Followup in the dual-mobility group was 3.3 6 0.8 years and followup in the large head groupwas 3.9 6 0.9 years. Primary endpoints included dislocation, rerevisions for dislocation, and reoperations, which were determined through our institution's total joint registry and verified by individual patient chart review. Age and body mass index were not different with the numbers available between the groups, but there was a slight predominance of females in the dual-mobility group (52{\%} [66 of 126] female) versus the 40-mm large head group (41{\%} [72 of 176] female) (p = 0.05). Notably, 33{\%} (41 of 126) of patients receiving the dual-mobility constructs had the index revision THA done for a diagnosis of recurrent dislocation versus 9{\%} (17 of 176) in the 40-mm large head group. Mean effective head size in the dual-mobility group was 47 mm (range, 38-58 mm). Results The subsequent frequency of dislocation in the dual-mobility construct group was less (3{\%} [four of 126] dual-mobility versus 10{\%} [17 of 176] in the 40-mm large head group; hazard ratio, 3.2 [1.1-9.4]; p = 0.03). Rerevision for dislocation in the dual-mobility construct group was less frequent (1{\%} [one of 126] dualmobility versus 6{\%} [10 of 176] in the 40-mm large head group; hazard ratio, 7.1 [0.9-55.6]; p = 0.03). Reoperation for any cause in the dual-mobility construct group was less frequent (6{\%} [eight of 126] dual-mobility versus 15{\%} [27 of 176] in the 40-mm large head group; hazard ratio, 2.5 [1.1-5.5]; p = 0.02); there were no differences between the groups in terms of the overall percentage of complications in each group. Conclusions When compared with patients treated with a 40-mm large femoral head, patients undergoing revision THA who received a dualmobility construct had a lower risk of subsequent dislocation, rerevision for dislocation, and reoperation for any reason in the first several years postoperatively. Those findings were present despite selection bias in this study to use the dual-mobility construct in patients at the highest risk for subsequent dislocation. Given the lower risk of subsequent dislocation, rerevision, and reoperation with the dual-mobility construct, some surgeons may wish to consider whether the role of dual-mobility should be judiciously expanded in contemporary revision THA.",
author = "Hartzler, {Molly A.} and Matthew Abdel and Sculco, {Peter K.} and Taunton, {Michael J.} and Mark Pagnano and Hanssen, {Arlen D.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1007/s11999.0000000000000035",
language = "English (US)",
volume = "476",
pages = "293--301",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
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}

TY - JOUR

T1 - Otto Aufranc Award

T2 - Dual-mobility Constructs in Revision THA Reduced Dislocation, Rerevision, and Reoperation Compared with Large Femoral Heads

AU - Hartzler, Molly A.

AU - Abdel, Matthew

AU - Sculco, Peter K.

AU - Taunton, Michael J.

AU - Pagnano, Mark

AU - Hanssen, Arlen D.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background Dislocation is one of the most common complications after revision THA. Dual-mobility constructs and large femoral heads (ie, 40 mm) are two contemporary, nonconstrained bearing options used in revision THA to minimize the risk of dislocation; however, it is not currently established if there is a clear benefit to using dualmobility constructs over large femoral heads in the revision setting. Questions/purposes We sought to determine if dual-mobility constructs would provide a reduction in dislocation, rerevision for dislocation, and reoperation or other complications as compared with large femoral heads in revision THA. Methods From 2011 to 2014, a series of 355 THAs underwent revision for any reason and received either a dualmobility construct (146 THAs) or a 40-mm large femoral head (209 THAs). Indications for either construct were based on surgeon judgment; however, there is a preference to use dual-mobility constructs in patients believed to be at higher risk of dislocation. In the dual-mobility group, 20 of 146 (14%) were excluded because of loss of followup before 2 years or because they had a dual-mobility shell cemented into a preexisting acetabular component. In the large head group, 33 of 209 (16%) were lost to followup before 2 years. Followup in the dual-mobility group was 3.3 6 0.8 years and followup in the large head groupwas 3.9 6 0.9 years. Primary endpoints included dislocation, rerevisions for dislocation, and reoperations, which were determined through our institution's total joint registry and verified by individual patient chart review. Age and body mass index were not different with the numbers available between the groups, but there was a slight predominance of females in the dual-mobility group (52% [66 of 126] female) versus the 40-mm large head group (41% [72 of 176] female) (p = 0.05). Notably, 33% (41 of 126) of patients receiving the dual-mobility constructs had the index revision THA done for a diagnosis of recurrent dislocation versus 9% (17 of 176) in the 40-mm large head group. Mean effective head size in the dual-mobility group was 47 mm (range, 38-58 mm). Results The subsequent frequency of dislocation in the dual-mobility construct group was less (3% [four of 126] dual-mobility versus 10% [17 of 176] in the 40-mm large head group; hazard ratio, 3.2 [1.1-9.4]; p = 0.03). Rerevision for dislocation in the dual-mobility construct group was less frequent (1% [one of 126] dualmobility versus 6% [10 of 176] in the 40-mm large head group; hazard ratio, 7.1 [0.9-55.6]; p = 0.03). Reoperation for any cause in the dual-mobility construct group was less frequent (6% [eight of 126] dual-mobility versus 15% [27 of 176] in the 40-mm large head group; hazard ratio, 2.5 [1.1-5.5]; p = 0.02); there were no differences between the groups in terms of the overall percentage of complications in each group. Conclusions When compared with patients treated with a 40-mm large femoral head, patients undergoing revision THA who received a dualmobility construct had a lower risk of subsequent dislocation, rerevision for dislocation, and reoperation for any reason in the first several years postoperatively. Those findings were present despite selection bias in this study to use the dual-mobility construct in patients at the highest risk for subsequent dislocation. Given the lower risk of subsequent dislocation, rerevision, and reoperation with the dual-mobility construct, some surgeons may wish to consider whether the role of dual-mobility should be judiciously expanded in contemporary revision THA.

AB - Background Dislocation is one of the most common complications after revision THA. Dual-mobility constructs and large femoral heads (ie, 40 mm) are two contemporary, nonconstrained bearing options used in revision THA to minimize the risk of dislocation; however, it is not currently established if there is a clear benefit to using dualmobility constructs over large femoral heads in the revision setting. Questions/purposes We sought to determine if dual-mobility constructs would provide a reduction in dislocation, rerevision for dislocation, and reoperation or other complications as compared with large femoral heads in revision THA. Methods From 2011 to 2014, a series of 355 THAs underwent revision for any reason and received either a dualmobility construct (146 THAs) or a 40-mm large femoral head (209 THAs). Indications for either construct were based on surgeon judgment; however, there is a preference to use dual-mobility constructs in patients believed to be at higher risk of dislocation. In the dual-mobility group, 20 of 146 (14%) were excluded because of loss of followup before 2 years or because they had a dual-mobility shell cemented into a preexisting acetabular component. In the large head group, 33 of 209 (16%) were lost to followup before 2 years. Followup in the dual-mobility group was 3.3 6 0.8 years and followup in the large head groupwas 3.9 6 0.9 years. Primary endpoints included dislocation, rerevisions for dislocation, and reoperations, which were determined through our institution's total joint registry and verified by individual patient chart review. Age and body mass index were not different with the numbers available between the groups, but there was a slight predominance of females in the dual-mobility group (52% [66 of 126] female) versus the 40-mm large head group (41% [72 of 176] female) (p = 0.05). Notably, 33% (41 of 126) of patients receiving the dual-mobility constructs had the index revision THA done for a diagnosis of recurrent dislocation versus 9% (17 of 176) in the 40-mm large head group. Mean effective head size in the dual-mobility group was 47 mm (range, 38-58 mm). Results The subsequent frequency of dislocation in the dual-mobility construct group was less (3% [four of 126] dual-mobility versus 10% [17 of 176] in the 40-mm large head group; hazard ratio, 3.2 [1.1-9.4]; p = 0.03). Rerevision for dislocation in the dual-mobility construct group was less frequent (1% [one of 126] dualmobility versus 6% [10 of 176] in the 40-mm large head group; hazard ratio, 7.1 [0.9-55.6]; p = 0.03). Reoperation for any cause in the dual-mobility construct group was less frequent (6% [eight of 126] dual-mobility versus 15% [27 of 176] in the 40-mm large head group; hazard ratio, 2.5 [1.1-5.5]; p = 0.02); there were no differences between the groups in terms of the overall percentage of complications in each group. Conclusions When compared with patients treated with a 40-mm large femoral head, patients undergoing revision THA who received a dualmobility construct had a lower risk of subsequent dislocation, rerevision for dislocation, and reoperation for any reason in the first several years postoperatively. Those findings were present despite selection bias in this study to use the dual-mobility construct in patients at the highest risk for subsequent dislocation. Given the lower risk of subsequent dislocation, rerevision, and reoperation with the dual-mobility construct, some surgeons may wish to consider whether the role of dual-mobility should be judiciously expanded in contemporary revision THA.

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