'Watch' cites concerns with intraprosthetic dislocation of dual-mobility hip implants

September 26, 2013, Journal of Bone and Joint Surgery

JBJS Case Connector, an online case journal published by The Journal of Bone and Joint Surgery, has issued a "Watch" regarding early intraprosthetic dislocation with dual-mobility hip implants. The "Watch" is based on two case reports published in the September 25th issue, in addition to recent cases in the orthopaedic literature pointing to similar problems.

In both cases of early intraprosthetic dislocation described in this issue of JBJS Case Connector, surgeons chose a mix-and-match strategy to minimize surgical complexity and and to maximize hip stability. Despite these sound clinical objectives, both cases suggest that combining dual-mobility components with components from manufacturers of non-dual-mobility systems may increase the risk of .

To enhance clinical outcomes and improve patient safety, JBJS Case Connector is committed to alerting the orthopaedic community about potentially problematic devices or . When two or more such cases with similar mechanisms appear, our editors will identify the procedure or implant as a "watchable" intervention to sharpen the focus of clinicians on the potential for similar problems and enhance and .

"The publication of 'Watches' helps fulfill our mission to serve the orthopaedic community," commented Marc Swiontkowski, MD, editor of JBJS Case Connector. "The 'Watch' designation may encourage the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further by rigorously evaluating the intervention and/or reporting related cases."

Study Details:

Key Findings:

  • Case Study #1: The authors surmise that the metal and polyethylene components had separated during an attempt at closed reduction of the dislocation when the patient had first presented. They suggest further that early intraprosthetic dislocations may be "generalizable to dual-mobility bearings and not related to the products of specific companies."
  • Case Study #2: In this case, the authors speculate that the mobile polyethylene ball and existing acetabular cup were incompatible in shape and design. Surgeons replaced the existing acetabular cup with a modular trabecular metal cup and implanted a ceramic modular bearing.

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