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Early Failure of Metal-on-Metal Large-Diameter Head Total Hip Arthroplasty Revised with a Dual-Mobility BearingA Case Report
Charles Riviere, MD1; Martin Lavigne, MD, MSc, FRCS1; Ahmed Alghamdi, MD, FRCS1; Pascal-André Vendittoli, MD, MSc, FRCS1
1 Department of Surgery, Hôpital Maisonneuve Rosemont, Université de Montréal, 5345 Boulevard L’Assomption, Montréal, QC H1T 2M4, Canada. E-mail addresss for C. Riviere: rivierech@gmail.com. E-mail address for M. Lavigne: lavigma2@hotmail.com. E-mail address for A. Alghamdi: ghamedli4u@hotmail.com. E-mail address for P-A. Vendittoli: pa.vendittoli@videotron.ca
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Investigation performed at the Hôpital Maisonneuve Rosemont, Université de Montréal, Montréal, Quebec, Canada



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Sep 25;3(3):e95 1-6. doi: 10.2106/JBJS.CC.L.00222
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Extract

Total hip arthroplasty with large metal-on-metal (MoM) bearings has been proposed as an option to achieve high stability in conjunction with low bearing wear1. However, cases of adverse reaction to metal debris (ARMD) have been reported2-4. Revision of failed MoM implants secondary to ARMD may have a poor clinical outcome, and recurrent dislocation is a concern5. Revisions usually consist of changing MoM bearings to metal-on-polyethylene or ceramic-on-ceramic couplings. The acetabular component needs to be replaced, at the cost of some bone loss, with a modular acetabular cup and a smaller diameter femoral head. Reduced head diameter, difficulty in changing patient habits (e.g., unrestricted range of motion following a total hip arthroplasty with a large-diameter head), and hip stabilizer attenuation may be substantial risk factors for hip dislocation after revision surgery. When abductor deficiency occurs, a constrained acetabular insert has been proposed to prevent dislocation2-4, but these devices are not ideal in a younger patient group; present failure rates are as high as 25% to 29%6,7. Aiming to minimize bone loss and postoperative instability and to avoid constrained implants, a new revision strategy that combines a dual-mobility femoral head in a retained monoblock cup has been proposed8. We report a case of early, catastrophic failure of such a conversion and identify the perceived reasons for failure. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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