# The Use of Dual-Mobility Implants Through a Direct Anterior Approach as a Safe and Effective Technique for Revision Hip Arthroplasty: The Two-Year Follow-Up of a Case Series

## TL;DR

This study shows that using dual-mobility implants with a direct anterior approach in hip revision surgery is safe and effective, with no dislocations in a high-risk group over two years.

## Contribution

The study provides new evidence on the safety and effectiveness of modular dual-mobility cups in revision hip arthroplasty using the direct anterior approach.

## Key findings

- No dislocations or deep infections were observed in 24 patients undergoing revision THA with MDM cups and DAA.
- Only one case of early aseptic loosening was reported, with no other signs of loosening or osteolysis.
- The procedure was effective in a high-risk population with a minimal two-year follow-up.

## Abstract

Background

Dislocation is one of the most prominent and challenging complications following the revision of total hip arthroplasty (THA). Dual-mobility cups are an option to address this problem. There is, however, little data on the outcomes of modern modular dual-mobility (MDM) cups in the revision of THA. In this study, the clinical and radiological outcomes following the revision of THA with an MDM cup using the direct anterior approach (DAA) were evaluated.

Methodology

We retrospectively reviewed patients who underwent a revision of THA between March 2017 and July 2019. The inclusion criteria were a revision of THA using an MDM cup through the DAA. A uniform acetabular implant was used in each revision. Outcome measures were assessed radiographically and clinically. The clinical outcome measures consisted of dislocation, infection, and re-revision. Functional assessment was performed using the Harris Hip Score preoperatively and at the last clinical examination in our department.

Results

This study retrospectively identified a cohort of 26 patients who underwent a revision of THA. Two patients were excluded due to incomplete follow-up because they died. Finally, 24 patients were included. A total of 17 isolated acetabular revisions and seven complete revisions were performed with a mean follow-up of 39 months (range = 29-59). No dislocations or deep infections were observed in our population to date. Except for one case of early aseptic loosening of the acetabular component, we observed no other signs of loosening, osteolysis, migration, or intraprosthetic dislocation.

Conclusions

THA revision through the DAA using an MDM cup is a safe and effective procedure. We observed no dislocation in a high-risk population undergoing THA revision surgery during a minimal follow-up of two years.