Influence of dual-mobility acetabular implants on revision and survivorship of cup and Kerboull-type reinforcement ring constructs in aseptic acetabular loosening

Introduction: Dual-mobility (DM) acetabular implants have been used in revision total hip arthroplasty (THA) to prevent postoperative instability, with excellent mid-term survivorship. However, few comparative studies assessed the long-term outcomes of DM implants used in Kerboull-type reinforcement ring constructs for acetabular revision. The present study aimed to compare long-term survivorship, dislocation rates and clinical outcome between DM acetabular implants and conventional single-bearing (SB) implants when cemented in a reinforcement ring. Hypothesis: Dual-mobility implants are associated with equivalent survivorship and lower dislocation rates than SB implants. Material and methods: A retrospective study included 60 revision THAs for aseptic loosening using a Kerboull-type reinforcement ring, and finally included 2 groups of 23 patients with either DM or SB cemented acetabular implants after matching for age, gender, BMI and preoperative Harris hip score. Mean follow-up was 10 years (range, 6-14 years). Acetabular implant survivorship, dislocation rate and radiographic failure incidence (> 5 mm migration, progressive radiolucency, graft non-integration, reinforcement ring breakage) were compared between the two groups. Clinical outcomes used the Harris hip score, the Postel-Merle d'Aubigne score and the Parker score. Results: Survivorship free of aseptic acetabular re-revision was 89% at 10 years, with no significant difference between DM and SB (91% and 86%, respectively; p = 0.54). Single-bearing implants showed a hazard ratio for dislocation of 6.7 (95% CI, 1.5-29.6; p = 0.01) compared to DM implants. There were no significant differences in radiologic failure (10-year survivorship 72% and 64%, respectively; p = 0.88) or functional scores.Discussion: The present study confirmed the impact of dual-mobility implants in reducing long-term dislocation risk when used in Kerboull-type reinforcement ring constructs for acetabular aseptic revision, with no increased risk of re-revision compared to conventional single-bearing implants. Level of evidence: III, comparative retrospective study.(c) 2021 Elsevier Masson SAS. All rights reserved.