Shah Urvil, Desai Mohan, Samant Vinay, Mehta Chandan
Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2024 Dec;14(12):185-191. doi: 10.13107/jocr.2024.v14.i12.5068.
Dual mobility (DM) total hip replacement (THR) features an acetabular component with an unconstrained tripolar build which ensures a greater range of motion without provoking any dislocation.We report three cases with extremes of surgical misadventure where we carried out a revision arthroplasty with a DM cup. The causes of the failure of the primary arthroplasty were multifactorial, even individually, and ranged from instability due to component malposition, trochanteric fracture, intrapelvic prosthesis protrusion, etc.
(1) Case 1 is a 40-year-old male, who following a failed fixation of a right proximal femur shaft fracture had undergone a proximal femur replacement outside with a proximal femur bipolar prosthesis and presented with a dislocated prosthesis due to excessive anteversion of 40 of the stem. Revision was done by inserting a DM cup without revising the stem to preserve the valuable femoral bone stock. (2) Case 2 is an 84-year-old comorbid female, who had come with right protrusio acetabuli with bipolar prosthesis in situ. The patient was managed with bone grafting and insertion of a DM cup with a peripheral fit. Greater trochanter wiring was done for the greater trochanter fracture (GTF) along with prophylactic posterior column plating. (3) Case 3 is a 60-year-old male, who had left sided chronic THR instability. He has had three previous episodes of dislocation which started after 7 years, when the patient fell and had a GTF. Here, the causes of instability were multifactorial- GTF, malposition, and liner wear. Instead of using a constrained liner and predisposing the patient to impingement, we did an isolated revision with a DM cup only.
The presented cases highlight the versatility and efficacy of utilizing a DM cup in revision arthroplasty for addressing diverse causes of primary hip arthroplasty failure. The adaptability is demonstrated in preserving the bone stock, managing bone loss, and addressing multifactorial instability, thereby emphasizing its widespread potential.
双动（DM）全髋关节置换术（THR）的髋臼组件具有无约束的三极结构，可确保更大的活动范围而不会引起任何脱位。我们报告了三例手术出现极端意外情况的病例，我们使用DM髋臼杯进行了翻修关节成形术。初次关节成形术失败的原因是多因素的，甚至是个体性的，包括组件位置不当导致的不稳定、转子骨折、盆腔内假体突出等。
（1）病例1是一名40岁男性，右股骨近端骨干骨折内固定失败后，在外部接受了股骨近端双极假体置换，因假体柄前倾40°过大而出现假体脱位。通过插入DM髋臼杯进行翻修，未对假体柄进行翻修以保留宝贵的股骨骨量。（2）病例2是一名84岁的合并症女性，因右髋臼前突且原位有双极假体前来就诊。患者接受了植骨并插入了外周贴合的DM髋臼杯。对大转子骨折（GTF）进行了大转子钢丝固定，并进行了预防性后柱钢板固定。（3）病例3是一名60岁男性，左侧慢性THR不稳定。他此前有过三次脱位发作，均在7年后患者跌倒并发生GTF后开始。这里，不稳定的原因是多因素的——GTF、位置不当和内衬磨损。我们没有使用限制性内衬并使患者易发生撞击，而是仅用DM髋臼杯进行了单独翻修。
所呈现的病例突出了在翻修关节成形术中使用DM髋臼杯来解决初次髋关节置换失败的多种原因的多功能性和有效性。其适应性体现在保留骨量方面，处理骨丢失以及解决多因素不稳定问题，从而强调了其广泛的潜力。
