Cemented and cementless dual mobility cups show similar fixation, low polyethylene wear, and low serum cobalt-chromium in elderly patients: a randomized radiostereometry study with 6 years’ follow-up

BACKGROUND AND PURPOSE: Dual mobility (DM) articulation total hip arthroplasty (THA) is used increasingly to reduce dislocation risk. We investigated cup fixation, polyethylene (PE) wear, serum chromium and cobalt ions, and their correlation to physical activity in patients with DM cups at 6-year follow-up. PATIENTS AND METHODS: In a patient-blinded RCT, 60 patients with hip osteoarthritis at a median age of 74 years (70–82) were randomly allocated to cemented (n = 30) or cementless hydroxyapatite-coated (n = 30) fixation of Avantage DM THA with a highly-crosslinked vitamin-E PE liner. Cup migration and PE wear were measured with radiostereometric analysis (RSA), chromium and cobalt ions were measured in serum, and physical activity was measured with accelerometers. RESULTS: At 6-year follow-up, proximal cup migration was similar: 0.14 mm (95% CI 0.01–0.28) for cemented cups and 0.21 mm (0.02–0.39) for cementless cups. The PE wear rate from 1- to 6-year follow-up was also similar: 0.06 mm/year (0.04–0.09) for cemented cups and 0.07 mm/year (0.04–0.11) for cementless cups. Serum metal ion levels were undetectable or very low. Physical activity was mainly low intensity and did not correlate to PE wear rate or cup migration. CONCLUSION: Cemented and cementless DM cups with highly crosslinked vitamin-E infused liners have similar cup migration and PE wear when used for primary THA surgery.