Tripolar Constrained and Dual Mobility Liners Are Both Successful When Cemented Into Tantalum Acetabular Revision Shells in Complex Revision Total Hip Arthroplasty

BACKGROUND: Instability is a common complication after revision total hip arthroplasty. Tripolar constrained (TC) and dual mobility (DM) liners cemented into tantalum acetabular revision (TM) shells are established alternatives that reduce instability risk. This study compares outcomes of TC and DM liners cemented into TM shells in complex revision hip replacements. METHODS: Fifty cases using a TM shell and a TC or DM cemented liner with at least 12 months of follow-up were identified. There were 25 TC and 25 DM liners. Clinical, radiographic, and patient-reported outcomes were collected. Reasons for re-revision and failures were analyzed. RESULTS: The average age was 73 years in the TC group and 75 years in the DM group. The median follow-up duration was 50 months (23 - 96) and 13 months (12 – 21) for the TC and DM groups, respectively. The mean Harris Hip Score improved from 37 to 61 for the TC group and from 51 to 73 in the DM group at the last review. Two TC cases required revision for wear and liner failure. One DM insert was changed at reoperation for periprosthetic femur fracture. There were no failures of cement fixation in either group and no revisions for cup loosening. CONCLUSIONS: In complex revision hip replacement with a history of instability or judged to have a high risk of instability postoperatively, TC and DM liners cemented into tantalum revision shells are both successful, giving acceptable results. The improved arc of movement with DM liners, minimizing impingement, makes them preferable except when there is a global abductor deficiency or severe joint laxity.