DOI: 10.2106/JBJS.CC.L.00222

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Issn Print: 2160-3251

Publication Date: 2013/07/01


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Early Failure of Metal-on-Metal Large-Diameter Head Total Hip Arthroplasty Revised with a Dual-Mobility Bearing: A Case Report

Charles Riviere; Martin Lavigne; Ahmed Alghamdi; Pascal-André Vendittoli

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Author Information: Department of Surgery, Hôpital Maisonneuve Rosemont, Université de Montréal, 5345 Boulevard L’Assomption, Montréal, QC H1T 2M4, Canada. E-mail addresss for C. Riviere:

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Excerpt

Total hip arthroplasty with large metal-on-metal (MoM) bearings has been proposed as an option to achieve high stability in conjunction with low bearing wear1. However, cases of adverse reaction to metal debris (ARMD) have been reported2-4. Revision of failed MoM implants secondary to ARMD may have a poor clinical outcome, and recurrent dislocation is a concern5. Revisions usually consist of changing MoM bearings to metal-on-polyethylene or ceramic-on-ceramic couplings. The acetabular component needs to be replaced, at the cost of some bone loss, with a modular acetabular cup and a smaller diameter femoral head. Reduced head diameter, difficulty in changing patient habits (e.g., unrestricted range of motion following a total hip arthroplasty with a large-diameter head), and hip stabilizer attenuation may be substantial risk factors for hip dislocation after revision surgery. When abductor deficiency occurs, a constrained acetabular insert has been proposed to prevent dislocation2-4, but these devices are not ideal in a younger patient group; present failure rates are as high as 25% to 29%6,7. Aiming to minimize bone loss and postoperative instability and to avoid constrained implants, a new revision strategy that combines a dual-mobility femoral head in a retained monoblock cup has been proposed8. We report a case of early, catastrophic failure of such a conversion and identify the perceived reasons for failure. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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