This combined clinical and in vitro study aimed to determine the incidence of liner malseating in modular dual mobility (MDM) constructs in primary total hip arthroplasties (THAs) from a large volume arthroplasty centre, and determine whether malseating increases the potential for fretting and corrosion at the modular metal interface in malseated MDM constructs using a simulated corrosion chamber. For the clinical arm of the study, observers independently reviewed postoperative radiographs of 551 primary THAs using MDM constructs from a single manufacturer over a three-year period, to identify the incidence of MDM liner-shell malseating. Multivariable logistic regression analysis was performed to identify risk factors including age, sex, body mass index (BMI), cup design, cup size, and the MDM case volume of the surgeon. For the in vitro arm, six pristine MDM implants with cobalt-chrome liners were tested in a simulated corrosion chamber. Three were well-seated and three were malseated with 6° of canting. The liner-shell couples underwent cyclic loading of increasing magnitudes. Fretting current was measured throughout testing and the onset of fretting load was determined by analyzing the increase in average current.Aims
Methods
Enhanced stability using dual mobility has been demonstrated but concerns about potential for corrosion in modular versions have been raised. Case reports of corrosion with malseated inserts have heightened concerns over this modularity. Some have claimed that malseating is rare, the true frequency is unknown. The purpose of our investigation was to determine the incidence of liner malseating in dual mobility implants at our institution. 567 hips had primary modular dual mobility hip replacements (Biomet or Stryker) between 2016 and 2018. Post-operative radiographs were reviewed independently by two reviewers to identify malseating. Liners were considered malseated if there was a noticeable gap between the metal liner and acetabular shell(figure 1). All liners deemed to be malseated were independently assessed by 3 separate reviewers for confirmation.Introduction
Methods
