Case Reports   |    
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
View Disclosures and Other Information

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
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


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.
Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Case Connector?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    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.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
  • Hip
  • Treatment & Procedures
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    California - UCLA/OH Department of Orthopaedic Surgery
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    Louisiana - Ochsner Health System