Dual-Mobility Cups in Primary Total Hip Arthroplasty

Abstract

Dual-mobility cups (DMCs) were introduced in France more than 40 years ago and are increasingly used not only in hip revision but also primary hip arthroplasty. Due to a simulated large-head articulation and increased jumping distance, DMCs can contribute to a high range of motion in the hip joint and reduce the risk of instability. Numerous studies have reported low dislocation rates and high survival rates in the mid-term follow-up. Nevertheless, long-term data, especially on primary hip replacement, remain limited, and the effect of recent designs and material innovations is still unclear. Therefore, primary DMCs are mainly proposed in patients at high risk for dislocation (i.e. pelvitrochanteric insufficiency, compromised spinopelvic mobility, neuromuscular disorders, obesity and femoral neck fractures). Based on a review of recently published studies referring to these indications, the current study discusses the advantages and disadvantages of DMCs.

Zusammenfassung

Tripolare Pfannen bzw. Dual-Mobility-Pfannen (dual mobility cups, DMCs) wurden bereits vor über 40 Jahren in Frankreich eingeführt und erfahren nun auch in Deutschland zunehmende Anwendung – nicht nur in der Revisionsendoprothetik, sondern auch in der Primärendoprothetik. Durch das simulierte Großkopfprinzip mit doppelter Artikulation sollen DMCs einen hohen Bewegungsumfang im Hüftgelenk mit reduzierter Luxationsgefahr gewährleisten. Inzwischen zeigen zahlreiche Studien geringe Dislokationsraten sowie hohe Überlebensraten im mittelfristigen Follow-up. Es gibt allerdings noch relativ wenige Langzeitdaten, insbesondere zum Einsatz in der Primärendoprothetik und der Stellenwert von Material- bzw. Designvarianten ist bislang noch unklar. Aus diesem Grund werden DMCs in der Primärendoprothetik aktuell vor allem bei Patient*innen mit erhöhtem Instabilitätsrisiko propagiert. Dazu gehören insbesondere eine Insuffizienz der pelvitrochantären Muskulatur, die eingeschränkte spinopelvine Mobilität, neuromuskuläre Erkrankungen oder Adipositas permagna sowie der Einsatz in der Frakturendoprothetik. Basierend auf einer Literaturübersicht zu diesen Indikationen wird der aktuelle Diskussionsstand zusammengefasst.

Key words

dual mobility - tripolar cups - hip arthroplasty - dislocation - instability

Schlüsselwörter

Dual Mobility - tripolare Pfannen - Hüftendoprothetik - Luxation - Instabilität

^* This article is a republished version of: Bellova P, Goronzy J, Riedel R, Grothe T, Hartmann A, Günther KP. Dual-Mobility Cups in Primary Total Hip Arthroplasty. Z Orthop Unfall 2023;161(1):74–84.

Publication History

Article published online:
09 January 2025

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