Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population

Sudeep Kumar; Anup Kumar; Ravi Kumar

doi:10.4103/JODP.JODP_13_19

ORIGINAL ARTICLE

Year : 2019 | Volume : 2 | Issue : 3 | Page : 52-54

Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population

Sudeep Kumar¹, Anup Kumar¹, Ravi Kumar²
¹ Department of Orthopaedics, AIIMS Patna, Patna, Bihar, India
² Department of Orthopaedics, NMCH Patna, Patna, Bihar, India

Date of Submission	30-Sep-2019
Date of Decision	10-Oct-2019
Date of Acceptance	18-Oct-2019
Date of Web Publication	23-Dec-2019

Correspondence Address:
Sudeep Kumar
Associate Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Patna - 800 007, Bihar
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JODP.JODP_13_19

Abstract

Purpose: The aim was to evaluate the functional outcome and dislocation rate at a minimum of 1-year follow-up following total hip replacement (THR) using Stryker modular dual mobility (MDM) X3 Mobile Bearing Hip System. Materials and Methods: This was a prospective study. The sample size was twenty patients who had secondary osteoarthritis hip with age <60 years; who had no debilitating disease, neurological motor disease, or any history of hip fracture or infection; and those who had underwent primary uncemented THR. They were evaluated clinically using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Oxford Hip Score (OHS) and radiologically using routine radiographs. Results: The mean OHS at a minimum of 1-year follow-up was 40.40 ± 6.253, whereas WOMAC score was 93.85 ± 3.511. Correlational analysis of OHS and WOMAC score revealed very weak relationship (r = 0.165), and P = 0.486 was considered statistically not significant. Conclusion: The present study demonstrates that short-term follow-up of MDM THR is not worse than what is routinely used in the market.

Keywords: Arthroplasty, dislocation, modular dual mobility, young

How to cite this article:
Kumar S, Kumar A, Kumar R. Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population. J Orthop Dis Traumatol 2019;2:52-4

How to cite this URL:
Kumar S, Kumar A, Kumar R. Short-term outcome of total hip arthroplasty using dual-mobility cups for secondary osteoarthritis hip in the Indian population. J Orthop Dis Traumatol [serial online] 2019 [cited 2023 Jun 4];2:52-4. Available from: https://jodt.org/text.asp?2019/2/3/52/273882

Introduction

Total hip arthroplasty (THA) is considered one of the most successful surgical procedures providing pain relief and improvement of function in patients with end-stage hip arthritis that is nonresponsive to nonoperative treatments.^[1],[2] Burden of hip arthritis is on the rise, and it is estimated that ≥950,000 primary and revision THAs were performed globally in 2010.^[3] The outline of patients requiring total hip replacement (THR) is changing with time from the elderly whose activities are limited to household to young patients who aspire to obtain full function as healthy adults. Various sociocultural reasons require squatting and sitting cross-legged [Figure 1] and [Figure 2] whose fulfillment is important for patient's satisfaction, especially in rural India. Surgeons performing replacements are, therefore, presented with a distinctive challenge of fulfilling patient expectations and ensuring magnificent results and at the same time using the most evidence-based and cost-effective implants.

Figure 1: Sitting cross legged

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Figure 2: Squatting position

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Instability is a noteworthy cause of morbidity following THR. Great emphasis is being given to reduce the incidence of medical and mechanical complications after THR. Risk factors for instability after THR are multifactorial and may be patient specific (gender, age, and abductor deficiency) or related to operative variables (surgical approach, component malposition, and femoral head diameter).^[4] The incidence of instability after primary and revision replacement has been reported to be as high as 7% and 25%, respectively.^[5] The cumulative risk of first-time dislocation is 2% at 1 year and 7% after 15 years of primary hip replacement.^[6]

The dual articulation cup was developed by Professor Gilles Bousquet and André Rambert (Engineer) in 1974 and combined the “low-friction” principle of THA popularized by Charnley^[7] with the McKee–Farrar concept of using a larger-diameter femoral head to enhance implant stability.^[8] The goal was to obtain maximum mobility in stable condition with least wear and tear. The first-generation dual-mobility cups (DMCs) had certain complications such as premature wear of polyethylene (intraprosthetic dislocation), insufficient means of bony fixation, and iliopsoas tendon impingement.^[9],[10] However, now, with advancements in the second- and third- generation DMCs' design, they have proven to yield lower mechanical complications when compared to the conventional cups.^[11]

We present our short-term series of cases performed in the population whose cultural demand requires sitting on the floor. The aim was to evaluate the functional outcome and dislocation rate at a minimum of 1-year follow-up.

Materials and Methods

This was a prospective study conducted at a government tertiary care hospital in Patna, Bihar, from September 2017 to January 2019. Written informed consent was obtained from all participants. Ethical approval was taken from the institutional ethics committee. The sample size was of twenty patients. Both male and female genders constituted the study population. The age group varied from 17 to 60 years. Inclusion criteria were secondary osteoarthritis hip and a minimum follow-up of 1 year.

Exclusion criteria were the presence of a neurological motor disease, debilitating disease, a history of hip fracture or infection, and age ≥60 years.

Demographic data, etiology, type of approach, type of stem/acetabular cup, bearing surface, and coating were recorded. All patients underwent primary uncemented THR using Stryker Modular Dual Mobility (MDM) X3 Mobile Bearing Hip System.

Surgery was performed in lateral decubitus position using posterior Southern approach to the hip. We used tablet ecosprin 150 mg for postoperative deep-vein thrombosis prophylaxis routinely for 4 weeks. The patients were made to stand and walk with support under the supervision of a physiotherapist from postoperative day (POD) 1 unless and until contraindicated. Drain was used routinely for 24 h. X-rays were taken immediately postoperatively. Sutures were removed on POD 10. Patients were evaluated both clinically and radiologically on their respective follow-up visits. Our scheduled follow-ups were at 6 weeks, 3 months, 6 months, and at 1 year and thereafter, at 6-month interval. During the follow-up:

Routine X-ray pelvis with both hips in anteroposterior and cross-table lateral views was taken to assess for cup migration, progressive radiolucencies, or positional changes in the cup or stem
Clinical assessment was done using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Oxford Hip Score (OHS)
Assessment and analysis of any complications were observed.

No patient was lost to follow-up.

Statistical analysis was done using SPSS software SPSS software (SPSS Inc., Chicago, United states). The mean of continuous variables and P value were calculated. In order to study associations between two continuous variables, a Pearson's correlation coefficient was calculated. Differences were considered to be of statistical significance at P < 0.05 and highly significant at P < 0.001.

Results

Eighty percent (n = 16) of the patient population comprised males [Table 1]. It reflected the general population which visits our outpatient department. The mean age of the study group was 37.95 (17–60) years. Sixty percent (n = 12) of the patients had pathology in the right hip, whereas 40% (n = 8) had left hip involvement [Table 2]. None of the patients had bilateral hip involvement. Indications for THR were as follows: 14 (70%) osteonecrosis, three (15%) Perthes hip, and three (15%) failed aseptic bipolar prosthesis. Radiological assessment did not reveal any sign of stem failure, acetabular failure, femoral fracture, or heterotopic ossification.

Table 1: Gender distribution

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Table 2: Side distribution

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The mean OHS at a minimum of 1-year follow-up was 40.40 ± 6.253, whereas WOMAC score was 93.85 ± 3.511. Correlational analysis of OHS and WOMAC score revealed very weak relationship (r = 0.165), and P = 0.486 was statistically not significant [Table 3]. No patients in the series had a dislocation. One patient had delayed wound healing.

Table 3: Correlational analysis between Western Ontario and McMaster Universities Arthritis Index and Oxford Hip Score

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Discussion

Dual-mobility articulations may help decrease instability after THA.^{[4],[12],[13]} This may be attributed to the increased effective size of the femoral head as well as the expanded impingement-free range of motion. Primary indications of DMC are patients at higher risk of dislocation such as those with neuromuscular diseases; patients older than 75 years; and those with a history of prior hip surgery, revision surgery, and primary THA after femoral neck fracture or after tumor resection.^[14] Literature has limited reports of the role of MDM in young active patients, and this subset of a population definitely are at high risk of dislocation and more prone to wear and osteolysis. Epinette et al.,^[15] Puch et al.,^[16] and Assi et al.^[17] reported the outcome of MDM in young population, and they confronted no dislocation and intraprosthetic dislocation of mechanical cup failure.

Our study had excellent mean WOMAC and OHSs at a minimum of 1-year follow-up. Following primary THR, the incidence of dislocation was highest in the 1^st year, and our study had no case of dislocation. None of the patients in our study group had infection or mechanical loosening at the last follow-up. Certain problems such as osteolysis may arise later as it could not be detected with a short-term study.

This study has some limitations which have to be pointed out as follows:

Small sample size
Short-term follow-up.

Conclusion

The present study demonstrates that short-term follow-up of MDM THR is not worse than what is routinely used in the market. The DMC appears to be a safe surgical option where squatting or sitting cross-legged on the floor is one of the functional prerequisites, especially in rural population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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