In Vivo Dissociation Of A Dual Articulation Bearing In Revision THA - Case Report


  • Edward McPherson, MD FACS
  • Sherif Sherif, MD



Revision total hip arthroplasty (THA) can be a difficult reconstructive procedure that challenges the skills of even the adroit orthopaedic surgeon. Revision THA for aseptic failure after acetabular/pelvic fracture is one of the more difficult challenges in the realm of hip reconstruction. The high complication rate associated with this complex reconstruction remains the dominant obstacle for obtaining consistent satisfactory outcomes. The specific problems of boney defects, pelvic malalignment, heterotopic ossification, soft tissue scarring, and muscle atrophy compromise the goals of revision THA, which include osteointegration of implant to host bone, restoration of hip joint biomechanics, and joint stability12

Recurrent dislocation in revision THA is one of the more frustrating complications for both the patient and the surgeon, and it remains so even today. Despite this, there continues to be developments in surgical technique and prosthetic design to enhance prosthetic hip stability. One prosthetic design, the dual articulation hip bearing, was developed to enhance THA stability. The dual articulation concept was developed by professor Gilles Bousquet and engineer André Rambert in the late 1970’s14. The dual mobility design incorporates two articular surfaces within the THA bearing. The acetabular cup is composed of a metallic bearing that articulates with an ultra high molecular weight polyethylene (UHMWPE) ball. Within the UHMWPE head is an inner ball that is enclosed within the polyethylene (figure 1). This design concept increases hip primary arc range before impingement.

The Bousquet dual mobility concept has been used over the last 20 years in Europe with successful clinical outcomes6,7,9,11. In the United States, the dual articulation bearing design received FDA clearance in 2011. However, as with the addition of any modular part, there is the potential for new in-vivo failure mechanisms. With the dual mobility construct, the new failure mechanism is dissociation of the inner head1,10. We report in this case an early traumatic dissociation of a dual mobility bearing utilized in a complex revision THA. To our knowledge, this is the first reported case of a traumatic in-vivo disassembly of a dual articulation bearing THA.

Key Words: Dual Articulation, Dual Mobility, Active Articulation, THA, Revision, Dissociation, Dislocation


Adam P, Farizon F. Dual articulation retentive acetabular liners and wear: surface analysis of 40, retrieved polyethylene implants. Rev Chir Orthop Reparatrice Appar Mot. 2005; 91(7): 627-636.

Frantz L, Ropars M. Dual Mobility Cemented Cups Have Low Dislocation Rates in THA Revisions. Clin Orthop Relat Res. 2008; 466: 389–395.

Guyen O, Pibarot V. The use of Dual Mobility implants for primary total hip replacement in patients at risk for dislocation. Journées Lyonnaises de Chirurgie de la Hanche. 2008:163-170.

Guyen O, Pibarot V. Use of a Dual Mobility Socket to Manage Total Hip Arthroplasty instability. Clin Orthop Relat Res. 2009; 467: 465–472.

Guyen O, Shan Q. Dual Mobility Hip implant: effect on hip stability. Journées Lyonnaises de Chirurgie de la Hanche. 2008: 153-161.

Hamadouche M, Biau DJ. The Use of a Cemented Dual Mobility Socket to Treat Recurrent dislocation. Clin Orthop Relat Res. 2010; 468: 3248–3254.

Lautridou C, Lebel B. Survival of the cementless Bousquet dual mobility cup: Minimum 15 years follow up of 437 THA. Rev Chir Orthop Reparatrice Appar Mot. 2008; 94: 731-739.

Leclercq S, el Blidi S. Bousquet’s device in the treatment of recurrent dislocation of a total hip prosthesis. Apropos of 13 cases. Rev Chir Orthop Reparatrice Appar Mot. 1995; 81(5): 389-394.

Lecuire F, Benareau I. Intra-prosthetic dislocation of the Bousquet dual mobility socket. Rev Chir Orthop Reparatrice Appar Mot. 2004; 90(3): 249-255.

Lyons MC, MacDonald SJ. Dual Poly Liner Mobility Optimizes Wear and Stability in THA: Opposes. Orthopedics, 2011; 34(9): e449-451. Available from: Accessed March 25, 2011.

Massin P, Besnier L. Acetabular revision of total hip arthroplasty using a press-fit Dual Mobility cup. Orthopaedic and Traumatology: Surgery and research. 2010; 96: 9-13.

McPherson EJ. Adult Reconstruction. In: Miller MD, Thompson SR, Hart JA, eds. Review of Orthopaedics. 6th ed. Philadelphia, PA: Elsevier; 2012: 353-427.

Philippot R, Adam P. Survival of cementless dual mobility sockets: ten-year follow-up. Rev Chir Orthop Reparatrice Appar Mot. 2006; 92(4): 326-331.

Vielpeau C, Lebel B. The dual mobility socket concept: experience with 668 cases. International Orthopaedics (SICOT). 2011; 35: 225–230.




How to Cite

McPherson, MD FACS, E., & Sherif, MD, S. (2012). In Vivo Dissociation Of A Dual Articulation Bearing In Revision THA - Case Report. Reconstructive Review, 2(1).



Case Report