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[THR] Dual mobility acetabular cup vs traditional implant #1

Adam W

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I'm a 56-year-old male in good heath and an avid skier. I'm 6'1" and weigh 150 lbs. I retired from my career as a software engineer a couple of years ago and now ski four or five days a week during the winter. I hope to resume a similar schedule! At the end of March I fell skiing and shattered my femoral neck. I had surgery the same day but it's failed to heal due to high displacement non-union.

I'm scheduled for a THA this coming Wednesday, June 22, 2016. My surgeon, Dr. Edward Stolarski in Sarasota, performs over 400 of these each year. If I leave the decision up to him he will choose either a traditional ceramic on plastic prosthetic or a dual mobility cup after he opens up the hip and sees what size head he's able to use with the traditional version. If I prefer a dual mobility cup, though, he'll install one regardless. He has experience with both and says he doesn't use the dual mobility cup more often only due to the lack of long-term data on its effectiveness and durability.

This is a bigger decision than I'm usually called on to make. I'd love to hear from anyone who has an idea of the advantages and disadvantages of each approach.
 

Josephine

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Hi and welcome to BoneSmart! Please don't worry about what type of hip. They all have pretty good track records and there really is no difference between them. The reason surgeons use one or another is generally down to either they prefer the instrumentation that comes with it or the surgeons under whom they trained used them and therefore they have a tendency to follow what the boss does! All the ones you've mentioned are good and have excellent track records. Personally, I don't think it's fair of surgeons to offer this choice to patients as one needs a fair bit of medical and technical knowledge to understand the differences and in any case, that decision is what you are paying him the big bucks for! I also think it's a bit like booking a flight and having the airline ask you to choose what kind of plane you would prefer to go on! :wink:

Your responsibility lies along the lines on understanding the impact of the surgery upon you and how you should manage it. For that we have some excellent articles! Hope they help you.

Here are the BoneSmart mantras ....
- rest, elevate, ice and take your pain meds by the clock
- if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
- if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
- if you won't die if it's not done, don't do it
- never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
- be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery
Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Activity progression for THRs
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.
 
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Adam W

Adam W

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@Zelda, I'm OK with the lack of long-term data. I've been an early adopter in other areas of my life, sometimes but not always with good results. I expect it will be good for at least 10 years. Those rate to be the most active amongst those I have remaining. Technology will have advanced in a decade -- we may have something better by then. Whichever prosthetic I get, in fact I think the odds are that it will outlast me.
 
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Adam W

Adam W

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Thanks @Josephine !

I understand that I might be better off letting the surgeon decide, but I appreciate his giving me the choice. He knows infinitely more about the surgery, but I know more about my lifestyle and risk tolerance.
 

Zelda

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@Zelda, I'm OK with the lack of long-term data. I've been an early adopter in other areas of my life, sometimes but not always with good results. I expect it will be good for at least 10 years. Those rate to be the most active amongst those I have remaining. Technology will have advanced in a decade -- we may have something better by then. Whichever prosthetic I get, in fact I think the odds are that it will outlast me.
Then I think you have your answer! Although I would express it as a preference rather than an absolute and trust your surgeon's judgement.
 

Jaycey

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I'd leave it for the surgeon to decide. He will assess the condition of the joint once he is in and use the implant that fits that situation plus your lifestyle. My RTHR surgeon chose an implant for younger, more active patients. They have the experience and I assume you had a good conversation about your activity levels and expectations.
 
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Adam W

Adam W

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I'm going with the dual mobility cup, the Biomet G7, as my preferred option. I've told my surgeon, though, that if he has any difficulty with placement I'd also be happy with a traditional prosthetic.

They've asked me to report to the hospital at 7am. At least I won't be hungry for too long!
 

Horseshoe

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@Adam W , dual mobility sounds very modern and hope it lasts a long time for you. I can understand wanting some input, I'm the same way :wink: . Hope I've convinced my OS to give me ceramic on ceramic as I plan to resume my active lifestyle with modifications of course.
Wishing you an easy surgery and we will see you on the other side!
 
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Adam W

Adam W

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Good luck, @Horseshoe !

I understand that dual mobility is modern in the US only because the FDA approved it relatively recently. It was invented in France in the '70s and has been used there for a while. The devices keep improving, which I presume is why we don't have good long-term data on the current ones.

Earlier today I came across two articles addressing ceramic on ceramic prosthetics. They're from 2012, but they might interest you:

https://www.hss.edu/hss-journal-volume-8-number-3-october-2012.asp
 

Horseshoe

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@Adam W , seems France is at the cutting edge with THr's, that's great news. Odd question but wonder if a dual mobility feels the same as a regular implant? Sounds like you'll have excellent ROM, a regular human gumby :wink:

Thanks for the link regarding the CoC and possible fracture and squeak issues. Supposedly it's been improved, I have concerns about the polyethylene liner wear particles years down the line. Suppose each type has it's pro's and con's and my OS will have to determine the best fit once he's in there so to speak :snork:
 
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Adam W

Adam W

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Surgery went well. I've taken a short trip with a walker and will try another soon. I expect to be released tomorrow afternoon. The hospital is comfortable and has WiFi. The only downside is liquid meals so far.
 

Horseshoe

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Congratulations @Adam W ! Great to hear that you're doing so well so soon. Hope you get to go home tomorrow!!
 
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Adam W

Adam W

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I met with my surgeon this morning and he confirmed that he installed a dual mobility cup. He also said that given what he saw when he opened up my hip that it's what he would have chosen had I left the decision completely up to him.

Made it home 8 hours ago. Took a long nap, feeling good. Walking on crutches. I suppose I need to transition to the post-op forum now. Thanks for all the suggestions and well wishes!
 
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Adam W

Adam W

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I went skiing yesterday and I could not tell my artificial hip from the original.

I had numbness in my pinky and ring fingers on both hands for four months after the THA, presumably a result of the two months I spent on crutches before the surgery. The numbness subsided on its own, though it took longer than I expected.
 

Jaycey

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I went skiing yesterday and I could not tell my artificial hip from the original.
This is what it's all about. THR gives you your life back. Well done!
 

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