Revision total hip arthroplasty for instability and recurrent dissociation of the acetabular construct after it’s initial placement at the high hip center: a case report

Introduction: Total hip arthroplasty for osteoarthritis secondary to more severe types of developmental dysplasia is a complex procedure, associated with an increased risk of failure, including instability. Different positions of the center of rotation have been described.

Purpose: To demonstrate tactical and technical challenges of revision hip arthroplasty after initial high placement of the acetabular component.

Case report: A patient underwent primary hip arthroplsty for dysplasia with a high dislocation, an antiprotrusio cage was placed at the high hip center. Recurrent instability was encountered, and then two revisions with cementation of a dual mobility cup into a retained well-fixed cage resulted in dissociation of the constuct.

Сonclusion: Proximal and lateral placement of the acetabular component may have an advantage of reducing perioperative morbidity, but if it fails, the following revision is associated with additional difficulties.

1. Tikhilov R.M., Dzhavadov A.A., Karpukhin A.S., Vahramyan A.G., Demyanova K.A., Shubnyakov I.I. Revision Hip Arthroplasty with Initially High Position of the Acetabular Component: What’s Special? // Traumatology and Orthopedics of Russia. - 2020. - Vol. 26. - N. 3. - P. 9-20. doi: 10.21823/2311-2905-2020-26-3-9-20

2. Shubnyakov I.I., Riahi A., Denisov A.O., Korytkin A.A., Aliev A.G., Veber E.V., Muravyova J.V., Sereda A.P., Tikhilov R.M. The Main Trends in Hip Arthroplasty Based on the Data in the Vreden’s Arthroplasty Register from 2007 to 2020 // Traumatology and Orthopedics of Russia. - 2021. - Vol. 27. - N. 3. - P. 119-142. doi: 10.21823/2311-2905-2021-27-3-119-142

3. Wu C., Shu G., Xie X., Yuan X., Chen S. Meta-analysis of the Efficacy of the Anatomical Center and High Hip Center Techniques in the Treatment of Adult Developmental Dysplasia of the Hip. Biomed Res Int. 2022 Aug 30;2022:7256664. doi: 10.1155/2022/7256664

4. Stirling P., Viamont-Guerra M.R., Strom L., Chen A.F., Saffarini M., Nover L., Laude F. Does Cup Position at the High Hip Center or Anatomic Hip Center in THA for Developmental Dysplasia of the Hip Result in Better Harris Hip Scores and Revision Incidence? A Systematic Review. Clin Orthop Relat Res. 2021 May 1;479(5):1119-1130. doi: 10.1097/CORR.0000000000001618

5. Mortazavi S.M.J., Hosseini-Monfared P., Atilla B., Bilgen O.F., Gahramanov A., Kreuzer S., Razzaghof M., Shubnyakov I., Zagra L. Is There a Difference in the Outcome of Total Hip Arthroplasty Performed for Patients Who Have Developmental Dysplasia when the Acetabular Component Is Positioned in the Anatomical Position Versus the High Hip Center? J Arthroplasty. 2025 Feb;40(2S1):S145-S147. doi: 10.1016/j.arth.2024.10.074

6. Esmaeili S., Ghaseminejad-Raeini A., Ghane G., Soleimani M., Mortazavi S.M.J., Shafiei S.H. Total Hip Arthroplasty in Patients Who Have Crowe Type IV Developmental Dysplasia of the Hip: A Systematic Review. J Arthroplasty. 2024 Oct;39(10):2645-2660.e19. doi: 10.1016/j.arth.2024.05.031

7. Tikhilov R.M., Shubnyakov I.I., Denisov A.O., Pliev D.G., Shubnyakov M.I., Vahramyan A.G., Avdeev A.I. Is the Any Clinical Importance for Separation Congenitally Dislocated Hip in Adults into Types C1 and C2 by Hartofilakidis? // Traumatology and Orthopedics of Russia. - 2019. - Vol. 25. - N. 3. - P. 9-24. doi: 10.21823/2311-2905-2019-25-3-9-24

8. Kenney C., Dick S., Lea J., Liu J., Ebraheim N.A. A systematic review of the causes of failure of Revision Total Hip Arthroplasty. J Orthop. 2019 May 2;16(5):393-395. doi: 10.1016/j.jor.2019.04.011

9. Donovan R.L., Johnson H., Fernando S., Foxall-Smith M., Whitehouse M.R., Blom A.W., Kunutsor S.K. A Meta-Analysis of the Incidence and Temporal Trends of Postoperative Dislocation in Revision Total Hip Arthroplasty Utilizing Constrained Acetabular Components or Dual Mobility Implants. J Arthroplasty. 2023 May;38(5):957-969.e1. doi: 10.1016/j.arth.2022.11.007

10. Wegrzyn J., Thoreson A.R., Guyen O., Lewallen D.G., An K.N. Cementation of a dual-mobility acetabular component into a well-fixed metal shell during revision total hip arthroplasty: a biomechanical validation. J Orthop Res. 2013 Jun;31(6):991-7. doi: 10.1002/jor.22314

11. Chalmers B.P., Ledford C.K., Taunton M.J., Sierra R.J., Lewallen D.G., Trousdale R.T. Cementation of a Dual Mobility Construct in Recurrently Dislocating and High Risk Patients Undergoing Revision Total Arthroplasty. J Arthroplasty. 2018 May;33(5):1501-1506. doi: 10.1016/j.arth.2017.11.055

12. Wegrzyn J., Saugy C.A., Guyen O., Antoniadis A. Cementation of a Dual Mobility Cup Into an Existing Well-Fixed Metal Shell: A Reliable Option to Manage Wear-Related Recurrent Dislocation in Patients With High Surgical Risk. J Arthroplasty. 2020 Sep;35(9):25612566. doi: 10.1016/j.arth.2020.05.001

13. Chen Z., Bains S.S., Dubin J.A, Sax O.C., Gilson G.A., Jacobstein D.A., Nabet A., Nace J., Delanois R.E. Cementation of a Metal Dual Mobility Liner in Patients Undergoing Revision Total Hip Arthroplasty. Arthroplast Today. 2023 Dec 3;24:101270. doi: 10.1016/j.artd.2023.101270

14. Ranawat C.S., Dorr L.D., Inglis A.E. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. JJoint Surg. Am. 1980;62(7):1059-1065.

15. Paavilainen T. Total hip replacement for developmental dysplasia of the hip. Acta Orthop Scand. 1997 Feb;68(1):77-84. Doi: 10.3109/17453679709003983

16. Tikhilov R.M., Dzhavadov A.A., Ziganshin D.R., Zakhmatov N.S., Alekberov R.R., Shubnyakov I.I. Cementless Total Hip Arthroplasty With Paavilainen Femoral Shortening Osteotomy Can Provide Good Results at 10 Years in Patients Who Have Crowe IV Developmental Dysplasia of the Hip. J Arthroplasty. 2024 Sep;39(9):2316-2322. doi: 10.1016/j.arth.2024.04.026

17. Doehring T.C., Rubash H.E., Shelley F.J., Schwendeman L.J., Donaldson T.K., Navalgund Y.A. Effect of superior and superolateral relocations of the hip center on hip joint forces. An experimental and analytical analysis. J Arthroplasty. 1996 Sep;11(6):693-703. doi: 10.1016/s0883-5403(96)80008-8

18. Bicanic G., Delimar D., Delimar M., Pecina M. Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia. Int Orthop. 2009 Apr;33(2):397-402. doi: 10.1007/s00264-008-0683-z

19. Watts C.D., Martin J.R., Fehring K.A., Griffin W.L. Inferomedial Hip Center Decreases Failure Rates in Cementless Total Hip Arthroplasty for Crowe II and III Hip Dysplasia. J Arthroplasty. 2018 Jul;33(7):2177-2181. doi: 10.1016/j.arth.2018.02.039

20. Jasty M., Anderson M.J., Harris W.H. Total hip replacement for developmental dysplasia of the hip. Clin Orthop Relat Res. 1995 Feb;(311):40-5.

21. Yang T.C., Chen C.F., Tsai S.W., Chen W.M., Chang M.C. Does restoration of hip center with subtrochanteric osteotomy provide preferable outcome for Crowe type III-IV irreducible development dysplasia of the hip?? J Chin Med Assoc. 2017 Dec;80(12):803-807. doi: 10.1016/j.jcma.2017.06.006

22. Dapuzzo M.R., Sierra R.J. Acetabular considerations during total hip arthroplasty for hip dysplasia. Orthop Clin North Am. 2012 Jul;43(3):369-75. doi: 10.1016/j.ocl.2012.05.012

23. Xu J., Xu C., Mao Y., Zhang J., Li H., Zhu Z. Posterosuperior Placement of a Standard-Sized Cup at the True Acetabulum in Acetabular Reconstruction of Developmental Dysplasia of the Hip With High Dislocation. J Arthroplasty. 2016 Jun;31(6):1233-1239. doi: 10.1016/j.arth.2015.12.019

24. Eskelinen A., Helenius I., Remes V., Ylinen P., Tallroth K., Paavilainen T. Cementless total hip arthroplasty in patients with high congenital hip dislocation. J Bone Joint Surg Am. 2006 Jan;88(1):80-91. doi: 10.2106/JBJS.E.00037

25. Ding Z.C., Zeng W.N., Mou P., Liang Z.M., Wang D., Zhou Z.K. Risk of Dislocation After Total Hip Arthroplasty in Patients with Crowe Type IV Developmental Dysplasia of the Hip. Orthop Surg. 2020 Apr;12(2):589600. doi: 10.1111/os.12665

26. Shi X.T., Li C.F., Han Y., Song Y., Li S.X., Liu J.G. Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications. Orthop Surg. 2019 Dec;11(6):966-973. doi: 10.1111/os.12576

27. Sun C., Zhang Y., Li L.T., Ding H., Guo T., Zhao J.N. Long-Term Outcomes of Total Hip Arthroplasty With Transverse Subtrochanteric Shortening Osteotomy and Modular Stem in Crowe IV Developmental Dysplasia. J Arthroplasty. 2021 Feb;36(2):630-635. doi: 10.1016/j.arth.2020.08.031. Epub 2020 Aug 21. PMID: 32919844

28. Sirka A., Clauss M., Tarasevicius S., Wingstrand H., Stucinskas J., Robertsson O., Ochsner P.E., Ilchmann T. Excellent long-term results of the Müller acetabular reinforcement ring in primary total hip arthroplasty: A prospective study on radiology and survival of 321 hips with a mean follow-up of 11 years. Acta Orthop. 2016;87(2):100-5. doi: 10.3109/17453674.2015.1103607. Epub 2015 Oct 16. PMID: 26471881; PMCID: PMC4812069.

29. Kerboull M., Hamadouche M., Kerboull L. Total hip arthroplasty for Crowe type IV developmental hip dysplasia: a long-term followup study. J Arthroplasty. 2001 Dec;16(8 Suppl 1):170-6. doi: 10.1054/arth.2001.28368. PMID: 11742471.

30. Totoribe K., Chosa E, Yamako G., Zhao X., Ouchi K., Hamada H., Deng G. Acetabular reinforcement ring with additional hook improves stability in three-dimensional finite element analyses of dysplastic hip arthroplasty. J Orthop Surg Res. 2018 Dec 7;13(1):313. doi: 10.1186/s13018-018-1023-7. PMID: 30526630; PMCID: PMC6286562.

31. Liaw F., Govilkar S., Banks D., Kankanalu P., Youssef B., Lim J. Primary total hip replacement using Burch-Schneider cages for acetabular fractures. Hip Int. 2022 May;32(3):401-406. doi: 10.1177/1120700020957642

32. Malahias M.A., Sarantis M., Gkiatas I., Jang S.J., Gu A., Thorey F., Alexiades M.M., Nikolaou V.S. The modern Burch-Schneider antiprotrusio cage for the treatment of acetabular defects: is it still an option? A systematic review. Hip Int. 2023 Jul;33(4):705-715. doi: 10.1177/11207000221099817

33. Schmidt-Braekling T., Sieber D., Gosheger G., Theil J.C., Moellenbeck B., Andreou D., Dieckmann R. Dislocation rates with combinations of anti-protrusio cages and dual mobility cups in revision cases: Are we safe? PLoS One. 2019 Feb 7;14(2):e0212072. doi: 10.1371/journal.pone.0212072

34. Sereda A.P., Smetanin S.M. Dislocations after Hip Arthroplasty (Review) // Traumatology and Orthopedics of Russia. - 2020. - Vol. 26. - N. 2. - P. 180-200. doi: 10.21823/2311-2905-2020-26-2-180-200

35. John R., Jain A., Agarwal S., Thomas S., Agarwal S. Dissociation of Cemented Dual Mobility Socket from the Acetabulum in A Case of Recurrent Total Hip Arthroplasty Instability -A Novel Complication. J Orthop Case Rep. 2018 Nov-Dec;8(6):46-49. doi: 10.13107/jocr.2250-0685.1252

36. Tan T.L., Le Duff M.J., Ebramzadeh E., Bhaurla S.K., Amstutz H.C. Long-Term Outcomes of Liner Cementation into a Stable Retained Shell: A Concise Follow-up of a Previous Report. J Bone Joint Surg Am. 2015 Jun 3;97(11):920-4. doi: 10.2106/JBJS.N.01045

37. Schneider L., Philippot R., Boyer B., Farizon F. Revision total hip arthroplasty using a reconstruction cage device and a cemented dual mobility cup. Orthop Traumatol Surg Res. 2011 Dec;97(8):807-13. doi: 10.1016/j.otsr.2011.09.010

38. Kurdziel M.D., Ennin K.A., Baker K.C. Verner J.J. Increasing Liner Anteversion Decreases the Interfacial Strength of Polyethylene Liners Cemented Into Titanium-Alloy Acetabular Shells. J. Arthroplasty. 2016 Dec;31(12):2922-2925. doi: 10.1016/j.arth.2016.05.053

39. Williams J.T. Jr, Ragland P.S., Clarke S. Constrained components for the unstable hip following total hip arthroplasty: a literature review. Int Orthop. 2007 Jun;31(3):273-7. doi: 10.1007/s00264-006-0191-y

40. Mortazavi S.M.J., Ghadimi E., Ardakani M.V., Razzaghof M., Ghasemi M.A., Nili A., Vafaei A., Moharrami A., Rasta S. Risk factors of dislocation after total hip arthroplasty in patients with developmental dysplasia of the hip. Int Orthop. 2022 Apr;46(4):749-759. doi: 10.1007/s00264-021-05294-w

41. Shahbazi P., Jalilvand A.H., Ghaseminejad-Raeini A., Ghaderi A., Sheikhvatan M., Fallah Y., Shafiei S.H. Risk Factors for Dislocation following Total Hip Arthroplasty in Developmental Dysplasia of the Hip: A Systematic Review and Meta-Analysis. Int Orthop. 2023 Dec;47(12):3063-3075. doi: 10.1007/s00264-023-05949-w

42. Ukaj S., Krasniqi S., Ukaj D., Dervishaj F., Dyla D., Muçaj S., Tahirbegolli B. Total hip arthroplasty for crowe type IV developmental dysplasia of the hip using a dual mobility acetabular cup. Sci Rep. 2025 Mar 7;15(1):7982. doi: 10.1038/s41598-024-81716-0

43.