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The benefit of the systematic revision of the acetabular implant in favor of a dual mobility articulation during the treatment of periprosthetic fractures of the femur: a 49 cases prospective comparative study

  • Original Article • HIP - TRAUMA
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

The SOFCOT symposium (2005) on periprosthetic fractures of the femur (PFFs) highlighted a high rate of dislocation (15.6% at 6 months) after change of prosthesis. So far, no study has ever proved the benefit of dual-mobility articulation during PFFs revisions. We conducted a comparative study on two prospective cohorts in order to (1) assess the influence of systematic acetabular revision in favor of a double mobility on dislocation rate (2) and in order to evaluate the rate of morbidity associated with this extra surgical procedure.

Hypothesis

A systematic replacement of the cup in favor of a dual-mobility articulation enables to reduce the dislocation rate in PFFs revisions without increasing morbidity.

Methodology

We compared two prospective multicenter cohorts over a year (2005 and 2015) using the same methodology. Any fracture around hip prosthesis which occurred 3 months at least after surgery was included. Data collection was clinical and radiological on preoperative, intraoperative and 6 months after surgery. The 2015 “bipolar” group (n = 24) included patients who had a bipolar revision (both femoral and dual-mobility articulation). The 2005 “unipolar” group (n = 25) included patients who had only a femoral implant revision. Patients were comparable by age (p = 0.36), sex (p = 0.91), ASA score (p = 0.36), history of prosthetic revision (p = 1.00), Katz score (p = 0.50) and the type of fracture according to the Vancouver classification (p = 0.55).

Results

There was a 4% rate of dislocation in the “bipolar group” while there was 21% rate of dislocation in the “unipolar group” (8% of recurrent dislocation) (p = 0.19). The rate of all-cause complications 6 months after surgery was not significantly different (p = 0.07): 12.5% in the 2015 “bipolar” cohort (one dislocation, one non-symptomatic cup migration and one pseudarthrosis of the major trochanter) versus 35% in the “unipolar” cohort (5 dislocations, 1 major trochanter fracture and 1 femur pseudarthrosis, 1 secondary displacement associated with a superficial infection). The surgical revision after 6 months was not significantly different (1/23 or 4% vs. 4/25 or 16%, p = 0.35).

Conclusion

We confirm the low rate of dislocations after fitting a dual-mobility cup in case of revision of the femoral side in case of periprosthetic femoral fracture, as well as the need for additional cases to be carried out upon further studies to significantly confirm the interest of preventing instability after femoral revision.

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Acknowledgements

We thank Professors H. Thomazeau and T. Bégué, co-directors of the SOFCOT symposium on periprosthetic fractures around the hip, for allowing us to use patient data from the 2005 prospective study. We thank Professor H. Migaud for his help at each step of the elaboration of the conception and redaction of this study. We thank Doctor A. Lereuil for his help in the translation.

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Authors and Affiliations

  1. Department of Orthopedic Surgery and Traumatology, CHRU de Lille, Place de Verdun, 59037, Lille Cedex, France

    A. Perrin, M. Saab, S. Putman, K. Benad & C. Chantelot

  2. Lille Nord University, 59000, Lille, France

    A. Perrin, M. Saab, S. Putman, K. Benad & C. Chantelot

  3. Department of Orthopedic Surgery and Traumatology, Hospital Group of the Catholic Institute of Lille, Saint-Philibert Hospital, Rue du Grand But, 59160, Lomme, France

    A. Perrin

  4. Public Health Department: Epidemiology and Quality of Care, Biostatistics Unit, EA 2694, F-59000, Lille, France

    E. Drumez

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  1. A. Perrin
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  2. M. Saab
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  3. S. Putman
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  4. K. Benad
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  6. C. Chantelot
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Correspondence to A. Perrin.

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Conflict of interest

C. Chantelot is a consultant and a designer for Evolutis. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Perrin, A., Saab, M., Putman, S. et al. The benefit of the systematic revision of the acetabular implant in favor of a dual mobility articulation during the treatment of periprosthetic fractures of the femur: a 49 cases prospective comparative study. Eur J Orthop Surg Traumatol 28, 239–246 (2018). https://doi.org/10.1007/s00590-017-2037-2

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  • DOI: https://doi.org/10.1007/s00590-017-2037-2

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