Outcome of Dual Mobility Constructs for Adverse Local Tissue Reaction Associated Abductor Deficiency in Revision Total Hip Arthroplasty

Treatment of adverse local tissue reaction (ALTR) is challenging owing to high complications and poor outcomes after a revision surgery. As dislocation is the most common cause of reoperation, it is often necessary to use advanced articulations such as dual mobility. This study aims to evaluate the outcome and complication rates after revision surgery with dual mobility constructs, compared to constrained and conventional articulations in the setting of significant abductor deficiency due to ALTR. Out of a total of 338 revision total hip arthroplasties for ALTR, 234 patients with a significant tissue necrosis and abductor muscle insufficiency (grade 3) were evaluated. The complication rates after revisions were compared between 42 hips with dual mobility implants, 24 hips with constrained liners, 104 hips with large diameter heads (36-40 mm), and 64 hips with small diameter heads (≤32 mm). After an average of 4 years of follow-up (2.8-8.6), the dual mobility articulation had no dislocation, compared to 4.1% and 15.5% for constrained liner and conventional articulations, respectively (P < .001). Utilization of dual mobility and constrained liner cup also did not increase the risk of nondislocation complications, including periprosthetic joint infection and periprosthetic fracture (P = .18 and .52). This study demonstrates significantly lower dislocation rates for dual mobility when compared to conventional articulations and comparable to constrained liners in cases of severe abductor deficiency due to ALTR, suggesting that dual mobility implants are viable surgical treatment alternatives to constrained liners to minimize dislocation during revision total hip arthroplasty in the setting of significant abductor deficiency due to ALTR.