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Total Hip Arthroplasty with a Large-Diameter Metal-on-Metal Cup (Durom) and a Standard Stem: Short-Term Results

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Total Hip Arthroplasty

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Abstract

Introduction: Large-diameter metal-on-metal (LDMOM) cups have been used in total hip arthroplasty (THA) advocating superior results with respect to dislocation rates, range of motion, and long-term survival. The Durom cup used as part of the Durom hip resurfacing system has been incriminated with poor short-term results sometimes correlated to incorrect positioning of either the femoral or acetabular component due to poor exposure during this procedure. Our objective was to evaluate short-term results of the Durom cup used in conjunction with standard stems.

Methods: We prospectively followed all patients with a large-diameter metal-on-metal articulation (Durom) and a standard stem operated upon between 9/2004 and 9/2008. Patients were seen at follow-up for a clinical (Harris hip score (HHS), University College of Los Angeles (UCLA) scale, Visual Analogue Scale (VAS), and patient satisfaction), radiographic, and questionnaire assessment.

Results: Eighty-nine primary THAs in 80 patients (74% men) with a mean age of 52 (±12) years were included. Main diagnoses were primary osteoarthritis in 47% and aseptic necrosis in 35%. An uncemented stem was used in 79%. Overall, 80 THAs were controlled at a mean follow-up of 39 months (range, 16–67 months); 4 patients were lost to follow-up, and 5 patients refused or were unable to attend the visit. However, none of the 5 underwent revision. Nine THAs (9/85, 9.4%) were revised in mean 30 months (range, 8–60 months) after the operation. The reasons for revision were aseptic loosening in three cases, presence of a granuloma (histological diagnosis of aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)) in four, deep infection in one, and impingement in one case. Radiographic analysis revealed linear (n = 2) and focal (n = 3) osteolysis as well as early cup migration (n = 2). In five of the revised patients, no radiographic changes were found. Fifty-five (69%) of the 80 patients with follow-up had a HHS between 80 and 100. Among those who were not revised, the mean HHS improved from 55.2 to 88.4 (mean increase 33.2, 95% CI 27.7; 38.7). The mean activity level (UCLA scale) at follow-up was 6.4 (±1.8). Overall, mild to severe pain was reported in 14 cases and occasional pain in 22. Groin pain was present in 18 patients (22.5%), 7 of them belonged to the revised group. Sixty-one (76.3%) of the 80 patients with follow-up were satisfied. Mean patient satisfaction on the VAS scale among those who were not revised was 9.0 (±1.3).

Conclusion: This study confirms the increased short-term revision rate of the large-diameter metal-on-metal couple (Durom) reported by others. In all revision cases, the retrieved cups showed no osteo-integration and were removed easily. Radiographic signs of implant loosening were not always present. For most revision cases, the operative indication was based upon groin pain and patient dissatisfaction.

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Authors and Affiliations

  1. Département de Chirurgie, Chirurgie Orthopédique et Traumatologie de l’appareil Moteur, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211, Genève 14, Switzerland

    Panayiotis Christofilopoulos, Anne Lübbeke, Charles Berton, Alexandre Lädermann, Martin Berli, Constantinos Roussos, Alexis Bonvin, Robin Peter & Pierre Hoffmeyer

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  1. Panayiotis Christofilopoulos
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  2. Anne Lübbeke
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  3. Charles Berton
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  4. Alexandre Lädermann
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  5. Martin Berli
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  6. Constantinos Roussos
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  7. Alexis Bonvin
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  8. Robin Peter
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  9. Pierre Hoffmeyer
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Correspondence to Panayiotis Christofilopoulos .

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  1. , 2nd Orthopaedic Department, Orthopaedic Hospital Vienna-Speising, Speisinger Straße 109, Vienna, 1130, Austria

    Karl Knahr

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Christofilopoulos, P. et al. (2012). Total Hip Arthroplasty with a Large-Diameter Metal-on-Metal Cup (Durom) and a Standard Stem: Short-Term Results. In: Knahr, K. (eds) Total Hip Arthroplasty. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27361-2_8

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  • DOI: https://doi.org/10.1007/978-3-642-27361-2_8

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  • Print ISBN: 978-3-642-27360-5

  • Online ISBN: 978-3-642-27361-2

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