Self-centering dual-mobility total hip systems: Prediction of relative movements and realignment of different intermediate components

The increased jump distance against dislocation and the large range of motion due to the enlarged effective head diameter substantiate the use of dual-mobility systems in cases of total hip joint instability. For this type of total hip endoprostheses, an eccentric design of the outer bearing is assumed in order to provide a force-dependent self-centering mechanism and an improved joint stability against dislocation. The purpose of this study was to determine the relative movements and realignment of different intermediate components during various motion cycles as a result of the eccentric design. We established a validated mathematical model for eccentric dual-mobility systems, which allowed a comparison of relative movements, self-centering torque and overall frictional torque during four different activities in order to analyze their motion behavior in everyday life. In addition, the impact of different radial clearances on the dynamic performance of the self-centering mechanism was investigated. According to torque patterns and the validation experiment, the main articulation of eccentric dual-mobility systems was limited to the smaller inner bearing for the most daily life activities, i.e. the eccentric intermediate component remained in its current position and only with changing activity did the intermediate component realign clearly. However, an inappropriate dimensioning of the radial clearance could lead to a permanent realignment of the intermediate component during the motion cycles. In general, the self-centering mechanism of the intermediate component seems to have no negative influence on relative movements and wear propagation of dual-mobility cup systems if the clearance and eccentricity are appropriately dimensioned.