- Original Paper
- Open Access
Absence of instabilities and intra-prosthetic dislocations at 7 to 11 years following THA using a fourth-generation cementless dual mobility acetabular cup
Journal of Experimental Orthopaedics volume 7, Article number: 51 (2020)
Dual-mobility (DM) cups are increasingly used in total hip arthroplasty (THA) but there lacks literature on their long-term results. We aimed to investigate outcomes of a fourth-generation cementless DM acetabular cup at 7–11 years.
We retrospectively evaluated 240 consecutive hips that received cementless THA using the same dual mobility cup (Novae Sunfit TH) and femoral stem (Corail). Patients were recalled at ≥7 years to collect Oxford hip scores (OHS), Harris hip scores (HHS), and inspect for radiolucent lines and granulomas. Multi-variable analyses were performed to determine whether HHS or OHS were associated with pre- or intra-operative variables.
At 8.4 ± 0.8 years (range, 7–11), 6 hips were revised (2.5%), 54 deceased (22.5%), and 14 could not be reached (5.8%). Four revisions (2 cup+stem, 2 liners only) were due to sepsis (1.7%), one (cup and stem) for trauma (0.4%), and one (stem) due to aseptic loosening (0.4%). For the remaining 166 hips, HHS was 83.6 ± 13.2 and OHS was 20.3 ± 6.7. Multi-variable analysis confirmed that HHS (β = − 0.38; p = 0.039) and OHS (β = 0.36; p < 0.001) worsened with age, and that OHS was worse for Charnley C patients (β = 3.17; p = 0.009). Neither granulomas nor radiolucenies were observed around any cups, but radiolucenies were seen around 25 stems (20.3%).
This fourth-generation DM cup demonstrated satisfactory outcomes at 7–11 years, with no instabilities or cup revisions due to aseptic loosening. Better OHS was observed for younger patients and those presenting higher Charnley grade.
Level of evidence
Level IV, retrospective case study.
Dislocation after total hip arthroplasty (THA) is a burdensome complication, observed in up to 10% of cases [2, 23, 36, 38], though one must consider heterogeneity among studied population, follow-up, and other confounding factors. Dual mobility (DM) cups became increasingly popular in recent years, as they proved effective at preventing articular instability, by virtue of increased ‘jump distance’ and ratio of head-to-neck diameter [25, 47]. Though the initial ‘Bousquet’ cup was prone to intra-prosthetic dislocations (IPD) and aseptic loosening [37, 40, 42, 46], design improvements over the past decades resolved many shortcomings of DM cups, thanks to enhanced press-fit and bioactive coatings [10, 31], as well as more durable liners made of ultra-high molecular weight polyethylene (UHMWPE) [37, 45].
Fourth-generation DM cups have proved effective at preventing IPD [11, 34, 46] and demonstrated promising complication and survival rates [18, 38, 39]. While originally intended for patients at risk of subluxation and dislocation, notably geriatric patients [1, 3] and those with femoral neck fractures [3, 24, 27, 28, 33, 41, 46] or neuromuscular deficit [9, 49], DM cups are increasingly used in younger and more active cohorts [31, 40, 49]. Their mid- to long-term outcomes yet are scarcely documented and could reassure clinicians worldwide of their benefits and suitability for a wider range of indications [2, 25, 33].
The primary goal of this study was to report revision rates, clinical scores and radiologic findings of a fourth-generation DM acetabular cup, in a sizeable multi-centre series with up to ten years of follow-up. The secondary goal was to identify demographic and operative factors that could compromise clinical scores and hence optimise future patient selection and surgical choices.
This study was prospectively designed prior to collecting data on retrospectively operated patients. The authors evaluated a consecutive series of 240 THAs (225 patients) performed over three consecutive years (June 2007 to June 10) using the same cementless dual mobility cup (Novae Sunfit TH, Serf, Décines, France) (Fig. 1) withthe same femoral stem (Corail, Depuy, Leeds, UK) by 3 surgeons (LJ, JCR, JCC). The femoral heads used were made of ceramic (n = 164) or metal (n = 76), and were of diameter 28 mm (n = 238) or 22 mm (n = 2). All implants had been approved and in routine clinical use before the inclusion period. The cohort comprised 81 men (93 hips) and 129 women (147 hips), aged 77.4 ± 5.6 years (range, 54–94), with body mass index (BMI) of 26.6 ± 4.6 (range, 17.9–40.6), ASA score of 2 ± 1 (range, 1–3) (Table 1). Preoperative walking ability was assessed using the Charnley classification . The etiology was primary osteoarthritis for 207 hips (87%), avascular necrosis for 18 hips (8%), and secondary osteoarthritis for 15 hips (6%). The procedures were performed through a posterior approach for 169 hips (70%) and anterolateral approach in 71 hips (30%). The mean cup size (diameter) used was 52.4 ± 3.0 (range, 47–63).
All patients were recalled for clinical and radiographic evaluation, and their case notes were used to document implant materials, models and diameters. From the initial cohort of 240 THAs, 3 had stem and cup revisions, 2 had liner and/or head replacement, and 1 had an isolated stem revision. In addition, 50 patients (54 hips) deceased, none of which had revision surgery, and 14 patients (14 hips) could not be contacted. The remaining 166 hips were assessed clinically at 8.4 ± 0.8 years (range, 7–11), of which 123 hips were also assessed radiographically. The clinical scores collected included the Oxford hip score (OHS, best = 12; worst = 60) , Harris hip score (HHS, best = 100; worst = 0) (best) , pain on visual analogic scale (pVAS, best = 0; worst = 10). The radiographic assessment included frontal weight-bearing pelvic radiographs that were inspected for radiolucent lines (> 2 mm wide) and granulomas in the 7 femoral Gruen zones  and 3 acetabular DeLee–Charnley zones [6, 14], and for Brooker heterotopic ossifications . All patients provided written informed consent for their participation in the study.
Normality of distributions was verified using the Shapiro–Wilk test. In case of non-parametric quantitative data, significance of differences between groups was assessed by the Mann–Whitney U test (Wilcoxon rank-sum test). Uni- and multi-variable linear regression analyses were performed after identification of relevant variables (age at surgery, gender, BMI, indications, Charnley grade, surgical approach, stem size and type and cup sizes), by backward selection using the threshold p = 0.15, to determine their associations with 2 main outcomes (HHS and OHS). Statistical analyses were performed using R version 3.5.2 (R Foundation for statistical computing, Vienna, Austria). P values < 0.05 were deemed statistically significant
From the cohort of 225 patients (240 hips), 6 patients (6 hips, 2.5%) were revised, 50 patients (54 hips, 22.5%) died, and 14 patients (14 hips, 5.8%) were lost to follow-up (Fig. 2). Four of the revisions were due to deep infection (1.7%), 2 of which required cup and stem exchange (0.8%) while 2 required only PE liner exchange (0.8%). One of the revisions was due to periprosthetic femoral fracture secondary to trauma which required cup and stem exchange (0.4%), and only one revision was due to aseptic loosening and required isolated stem revision (0.4%). There were no dislocations recorded. Furthermore, there were 21 complications that did not require revision (8.8%), including 2 deep infections treated by lavage (0.8%), as well as 12 intraoperative femoral cracks (5%), all observed during broaching (Fig. 3) and resolved using cerclage wires, 3 of which later developed iliopsoas impingements (1.3%).
For the final cohort of 155 patients (166 hips) who still have their original implants in place the HHS improved from 41.7 ± 13.1 (range, 10–74) preoperatively, to 83.6 ± 13.2 (range, 8–99) postoperatively (Table 2). Their OHS was 20.3 ± 6.7 (range, 12–42) and pVAS was 0.6 ± 1.3 (range, 0–7). Uni-variable analysis revealed that HHS worsened with patient age (β = − 0.40p = 0.030) (Table 3) and that OHS worsened with patient age (β = 0.34; p < 0.001) and was worse for patients with Charnley C walking ability (β = 3.28; p = 0.009) (Table 4). Multi-variable analysis confirmed that HHS and OHS worsened with age (respectively, β = − 0.38; p = 0.039 and β = 0.36; p < 0.001) and that OHS was worse for patients with Charnley C walking ability (β = 2.87; p = 0.017).
Radiographic assessment was performed for 118 patients (123 hips) for which x-rays were available at final follow-up. We observed heterotopic ossification of grade I in 18 hips (14.6%), grade II in 2 hips (1.6%), and grade III in 1 hip (0.8%). Neither granulomas nor radiolucent lines were observed around any cups, but there were radiolucenies around 25 femoral stems (20.3%): 24 in Gruen zone 1 (19.5%) and 1 in Gruen zone 7 (0.8%).
This study demonstrated satisfactory clinical and radiographic outcomes of cementless THA using a fourth-generation DM acetabular cup, with a cumulative revision rate of 2.5% at a mean follow-up of 8.4 years. It is important to note, however, that only one revision (0.4%) was due to aseptic loosening, and required femoral component exchange, but that there were no cup revisions, due to either instability or aseptic loosening. Deep infection remained the principal cause of revision (1.7%) and only one hip was revised for periprosthetic fracture (0.4%) secondary to trauma. Our cumulative revision rate is within the range reported for fourth-generation DM acetabular cups [7, 8, 16,17,18, 21, 22, 31, 32, 51, 52]. While numerous smaller series (40–104 hips) [31, 32, 51, 52] had no revisions of any kind at 5 to 10 years of follow-up, larger cohorts (167–3474 hips) [7, 8, 16,17,18, 21, 22] had overall revision rates between 0.5% and 3.6%, at 5 to 13 years of follow-up.
Dual mobility acetabular cups proved increasingly popular in recent years as they allow improved range of motion and prevent instabilities [25, 47]. Fourth-generation DM acetabular cups, with optimized bearing surfaces, liner materials and coatings, have reduced the risks of intra-prosthetic dislocations and the need for subsequent revisions [37, 40, 42, 46]. However, there still remains a lack of published studies concerning their mid- to long-term outcomes.
Recent studies indicated that deep infection is the most common cause for revision of DM acetabular cups , which may be explained by the infirmity and comorbidities of the older population in which they are implanted . In this series, the cumulative rate of revision for infection was 1.7%, at 8.4 years which is slightly higher than the rate of 1.0% at 5 years, reported for all hip arthroplasty infections in the Danish hip registery .
This study revealed no intra-prosthetic instabilities at either the liner-cup junction or at the liner-head junction, which proves that 28 mm heads are compatible with this stem and cup combination . According to the current literature, it is clear that DM is the best option to prevent instabilities after THA, particularly in women, elderly and obese patients, as well as those with elevated ASA scores or neuromuscular deficits [3, 35, 47]. Moreover, it is still debateable whether larger femoral head sizes should be used, as they are associated with lower risks of dislocations but increased PE wear [26, 30, 48]. Our study revealed no dislocations using 28 mm heads. Using larger femoral head sizes could exacerbate PE wear, debris and osteolysis , whereas using 22 mm heads, would increase the risk of intra-prosthetic instabilities by reducing the neck to head ratio, which causes earlier impingement between the stem neck and the retentive cup rim [12, 44]. Psoas impingement was found in 3 hips (1.3%), all of which had intraoperative femoral cracks fixed using cerclage wires, which likely exacerbated tendon contact against implanted components. In a landmark anatomic study, Vandenbussche et al.  described the acetabular zone of psoas impingement, and warned that prosthetic overhang is more frequent with DM acetabular cups, because they are designed with a more protrusive rim.
For the present series, the median HHS and OHS at 7 to 11 years were 86 and 19 points respectively, and patient-repoted pVAS was 0. These outcomes compare favourably to scores repoted in recent studies on fourth-generation DM acetabular cups [7, 8, 18, 21, 32, 51, 52]. Our multi-variable analysis revealed significant influence of preoperative Charnley disability index and age on OHS, both of which are not surprising. Postoperative radiographic analysis revealed absence of radiolucent lines around the acetabular cup, suggesting adequate osteointegration for all cases. Regarding the femur, radiolucent lines could be observed around 25 stems (20%) mostly in Gruen zone 1. No granulomas were noted around the stems or the cups.
The main limitations of the present study are its retrospective design, and hence considerable proportion of patients lost to follow-up (8%) or missing radiographic images (26%). The advanced age of many of the patients may have contributed to the high numbers that were lost to follow-up, but they shared the same standard demographics and surgical parameters as the rest of the series. It is noteworthy that the clinical follow-up was longer than the radiographic follow-up. Despite the size of the initial cohort and follow-up at 7 to 11 years, the present data may be insufficient to confirm elimination of rare complications such as instabilities and intra-prosthetic dislocations, which require larger cohorts with prospective follow-up. National registries provide larger datasets for more robust conclusions on complications and survival but the heterogeneity of implant models and surgical techniques, as well as the paucity of preoperative and surgical data do not enable identification of risk factors. Furthermore, this study is not comparative and cannot therefore decide on the relative functional or cost benefits as compared with unipolar cups. The principal strength of the study is the sizeable cohort, which includes patients susceptible to instabilities, and relatively extended follow-up for a fourth-generation generation of DM acetabular cups. Although two stem head materials were used and two different surgical approaches applied, the same DM acetabular cup design was used throughout the study which allows the authors to draw clear conclusions.
This study presented satisfactory radiographic and clinical mid-term outcomes of cementless THA using a fourth-generation DM acetabular cup, with no instabilities or revisions due to aseptic loosening. Better HHS and OHS were observed for younger patients and those with preoperative Charnley grade A. Further studies should consider tribologic aspects of DM acetabular cups to confirm the best bearing couples that would minimize wear and metal ion release in the long-term.
Availability of data and materials
Total Hip Arthroplasty
Ultra-High Molecular Weight Polyethylene
Body Mass Index
Oxford Hip Score
Harris Hip Score
Pain on Visual Analogic Scale
Acker A, Fischer JF, Aminian K, Lecureux E, Jolles BM (2017) Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up. Orthop Traumatol Surg Res 103(1):21–25
Batailler C, Fary C, Verdier R, Aslanian T, Caton J et al (2017) The evolution of outcomes and indications for the dual-mobility cup: a systematic review. Int Orthop 41(3):645–659
Boukebous B, Boutroux P, Zahi R, Azmy C, Guillon P (2018) Comparison of dual mobility total hip arthroplasty and bipolar arthroplasty for femoral neck fractures: a retrospective case-control study of 199 hips. Orthop Traumatol Surg Res 104(3):369–375
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632
Byrd JW, Jones KS (2000) Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy 16(6):578–587
Callaghan JJ, Dysart SH, Savory CG (1988) The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series. J Bone Joint Surg Am 70(3):337–346
Chughtai M, Mistry JB, Diedrich AM, Jauregui JJ, Elmallah RK et al (2016) Low frequency of early complications with dual-mobility acetabular cups in Cementless primary THA. Clin Orthop Relat Res 474(10):2181–2187
Combes A, Migaud H, Girard J, Duhamel A, Fessy MH (2013) Low rate of dislocation of dual-mobility cups in primary total hip arthroplasty. Clin Orthop Relat Res 471(12):3891–3900
Dagneaux L, Marouby S, Maillot C, Canovas F, Riviere C (2019) Dual mobility device reduces the risk of prosthetic hip instability for patients with degenerated spine: a case-control study. Orthop Traumatol Surg Res 105(3):461–466
Dangin A, Boulat S, Farizon F, Philippot R (2016) Prevention of dislocation risk during hip revision surgery with the dual mobility concept; study of a new generation of dual mobility cups. Surg Technol Int 29:314–319
Darrith B, Courtney PM, Della Valle CJ (2018) Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J 100-b(1):11–19
De Martino I, D'Apolito R, Waddell BS, McLawhorn AS, Sculco PK et al (2017) Early intraprosthetic dislocation in dual-mobility implants: a systematic review. Arthroplast Today 3(3):197–202
Delaunay C, Epinette JA, Dawson J, Murray D, Jolles BM (2009) Cross-cultural adaptations of the Oxford-12 HIP score to the French speaking population. Orthop Traumatol Surg Res 95(2):89–99
DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 121:20–32
Di Laura A, Hothi HS, Henckel J, Cerquiglini A, Liow MHL et al (2017) Retrieval evidence of impingement at the third articulation in contemporary dual mobility cups for total hip arthroplasty. Int Orthop 41(12):2495–2501
Ferreira A, Prudhon JL, Verdier R, Puch JM, Descamps L et al (2017) Contemporary dual-mobility cup regional and private register: methodology and results. Int Orthop 41(3):439–445
Fessy MH, Jacquot L, Rollier JC, Chouteau J, Ait-Si-Selmi T et al (2019) Midterm clinical and radiographic outcomes of a contemporary Monoblock dual-mobility cup in Uncemented Total hip arthroplasty. J Arthroplasty 34(12):2983–2991
Gaillard R, Kenney R, Delalande JL, Batailler C, Lustig S (2019) Ten- to 16-year results of a modern Cementless dual-mobility acetabular implant in primary Total hip arthroplasty. J Arthroplasty 34(11):2704–10
Gruen TA, McNeice GM, Amstutz HC (1979) "modes of failure" of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17–27
Gundtoft PH, Overgaard S, Schonheyder HC, Moller JK, Kjaersgaard-Andersen P et al (2015) The "true" incidence of surgically treated deep prosthetic joint infection after 32,896 primary total hip arthroplasties: a prospective cohort study. Acta Orthop 86(3):326–334
Guyen O, Pibarot V, Vaz G, Chevillotte C, Carret JP et al (2007) Unconstrained tripolar implants for primary total hip arthroplasty in patients at risk for dislocation. J Arthroplasty 22(6):849–858
Hamadouche M, Ropars M, Rodaix C, Musset T, Gaucher F et al (2017) Five to thirteen year results of a cemented dual mobility socket to treat recurrent dislocation. Int Orthop 41(3):513–519
Hernigou P, Dubory A, Potage D, Roubineau F, Flouzat Lachaniette CH (2017) Dual-mobility arthroplasty failure: a rationale review of causes and technical considerations for revision. Int Orthop 41(3):481–490
Homma Y, Baba T, Ozaki Y, Watari T, Kobayashi H et al (2017) In total hip arthroplasty via the direct anterior approach, a dual-mobility cup prevents dislocation as effectively in hip fracture as in osteoarthritis. Int Orthop 41(3):491–497
Horriat S, Haddad FS (2018) Dual mobility in hip arthroplasty: what evidence do we need? Bone Joint Res 7(8):508–510
Hwang JH, Kim SM, Oh KJ, Kim Y (2018) Dislocations after use of dual-mobility cups in cementless primary total hip arthroplasty: prospective multicentre series. Int Orthop 42(4):761–767
Jobory A, Karrholm J, Overgaard S, Becic Pedersen A, Hallan G et al (2019) Reduced revision risk for dual-mobility cup in Total hip replacement due to hip fracture: a matched-pair analysis of 9,040 cases from the Nordic arthroplasty register association (NARA). J Bone Joint Surg Am 101(14):1278–1285
Kim YT, Yoo JH, Kim MK, Kim S, Hwang J (2018) Dual mobility hip arthroplasty provides better outcomes compared to hemiarthroplasty for displaced femoral neck fractures: a retrospective comparative clinical study. Int Orthop 42(6):1241–1246
Kreipke R, Rogmark C, Pedersen AB, Karrholm J, Hallan G et al (2019) Dual mobility cups: effect on risk of revision of primary Total hip arthroplasty due to osteoarthritis: a matched population-based study using the Nordic arthroplasty register association database. J Bone Joint Surg Am 101(2):169–176
Lachiewicz PF, Soileau ES, Martell JM (2016) Wear and Osteolysis of highly crosslinked polyethylene at 10 to 14 years: the effect of femoral head size. Clin Orthop Relat Res 474(2):365–371
Laurendon L, Philippot R, Neri T, Boyer B, Farizon F (2018) Ten-year clinical and radiological outcomes of 100 Total hip arthroplasty cases with a modern Cementless dual mobility cup. Surg Technol Int 32:331–336
Martz P, Bourredjem A, Laroche D, Arcens M, Labattut L et al (2017) Rottinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up. Int Orthop 41(3):461–467
Nonne D, Sanna F, Bardelli A, Milano P, Rivera F (2019) Use of a dual mobility cup to prevent hip early arthroplasty dislocation in patients at high falls risk. Injury (50 Suppl 4):S26–S29.
Noyer D, Caton JH (2017) Once upon a time.... Dual mobility: history. Int Orthop 41(3):611–618
Ozden VE, Dikmen G, Beksac B, Tozun R (2018) Dual-mobility bearings for patients with abductor-trochanteric complex insufficiency. Hip Int 28(5):491–497
Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 22(4 Suppl 1):86–90
Philippot R, Neri T, Boyer B, Viard B, Farizon F (2017) Bousquet dual mobility socket for patient under fifty years old. More than twenty year follow-up of one hundred and thirty one hips. Int Orthop 41(3):589–594
Pituckanotai K, Arirachakaran A, Tuchinda H, Putananon C, Nualsalee N et al (2018) Risk of revision and dislocation in single, dual mobility and large femoral head total hip arthroplasty: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol 28(3):445–455
Prudhon JL, Desmarchelier R, Hamadouche M, Delaunay C, Verdier R (2018) Is dual mobility associated with an increased risk of revision for infection? Matched cohort of 231 cases of dual-mobility cups and 231 fixed cups. Hip Int 28(2):200–204
Puch JM, Derhi G, Descamps L, Verdier R, Caton JH (2017) Dual-mobility cup in total hip arthroplasty in patients less than fifty five years and over ten years of follow-up : a prospective and comparative series. Int Orthop 41(3):475–480
Rashed RA, Sevenoaks H, Shabaan AM, Choudry QA, Hammad AS et al (2018) Functional outcome and health related quality of life after dual mobility cup total hip replacement for displaced femoral neck fractures in middle aged Egyptian patients. Injury 49(3):667–672
Reina N, Pareek A, Krych AJ, Pagnano MW, Berry DJ et al (2019) Dual-mobility constructs in primary and revision Total hip arthroplasty: a systematic review of comparative studies. J Arthroplasty 34(3):594–603
Roder C, Staub LP, Eichler P, Widmer M, Dietrich D et al (2006) Avoiding misclassification bias with the traditional Charnley classification: rationale for a fourth Charnley class BB. J Orthop Res 24(9):1803–1808
Rowan FE, Benjamin B, Pietrak JR, Haddad FS (2018) Prevention of dislocation after Total hip arthroplasty. J Arthroplasty 33(5):1316–1324
Tabori-Jensen S, Frolich C, Hansen TB, Bovling S, Homilius M et al (2018) Higher UHMWPE wear-rate in cementless compared with cemented cups with the Saturne(R) dual-mobility acetabular system. Hip Int 28(2):125–132
Tabori-Jensen S, Hansen TB, Stilling M (2019) Low dislocation rate of Saturne((R))/Avantage((R)) dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg 139(5):605–612
Terrier A, Latypova A, Guillemin M, Parvex V, Guyen O (2017) Dual mobility cups provide biomechanical advantages in situations at risk for dislocation: a finite element analysis. Int Orthop 41(3):551–556
Tsikandylakis G, Karrholm J, Hailer NP, Eskelinen A, Makela KT et al (2018) No increase in survival for 36-mm versus 32-mm femoral heads in metal-on-polyethylene THA: a registry study. Clin Orthop Relat Res 476(12):2367–2378
Vahedi H, Makhdom AM, Parvizi J (2017) Dual mobility acetabular cup for total hip arthroplasty: use with caution. Expert Rev Med Devices 14(3):237–243
Vandenbussche E, Saffarini M, Taillieu F, Mutschler C (2008) The asymmetric profile of the acetabulum. Clin Orthop Relat Res 466(2):417–423
Vasukutty NL, Middleton RG, Young P, Uzoigwe C, Barkham B et al (2014) A double mobility acetabular implant for primary hip arthroplasty in patients at high risk of dislocation. Ann R Coll Surg Engl 96(8):597–601
Vermersch T, Viste A, Desmarchelier R, Fessy MH (2015) Prospective longitudinal study of one hundred patients with total hip arthroplasty using a second-generation cementless dual-mobility cup. Int Orthop 39(11):2097–2101
The authors are grateful to Ramsay Santé for funding the statistical analysis and manuscript preparation for this study.
Ethics approval and consent to participate
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board (IRB) who approved this study in advance (COS-RGDS-2019-01-003-Avis IRB-CHOUTEAU-J) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Authors LJ, JC, MB, JCC and JCR have received fees for educational and promotional events from DePuy-Synthes. Authors LJ, JC, MB, JCC and JCR have received royalties from DePuy-Synthes. Authors MS and LN declare that they have no conflict of interest.
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Chouteau, J., Rollier, JC., Bonnin, M.P. et al. Absence of instabilities and intra-prosthetic dislocations at 7 to 11 years following THA using a fourth-generation cementless dual mobility acetabular cup. J EXP ORTOP 7, 51 (2020). https://doi.org/10.1186/s40634-020-00265-3
- Clinical and radiographic outcomes
- Dual-mobility acetabular cup
- Cementless THA