Dr. Lachiewicz: Yes, I think you have to be careful. You’ve got to position the acetabular component correctly. You have to check for impingement. You can still get bone-bone impingement with dual mobility. One of the cases that we saw was due to an impingement of a skirt. If you are going to do dual mobilities, people in the audience, I would recommend against using a skirted femoral component.
Dr. Sculco: I think, the other thing Paul, I agree with you 100%. Just for the audience, you can’t put these implants in with poor position and think they’re going to be forgiving and you’re going to get away with it.
Moderator Maloney: Especially true with a constrained liner. Let’s take a scenario. You have a 65-year-old gentleman who’s got a malposition socket and it has come out four times. You’re going to do a socket revision. You take out the socket, are you going to put in a dual mobility, a constrained liner or a big femoral head? Paul you get first shot.
Dr. Lachiewicz: Nowadays I’m doing a dual mobility in that type of patient. Seems to be better…
Moderator Maloney: Are you using dual mobility now in all socket revisions?
Dr. Lachiewicz: Not on all, but almost all now. Because I’m doing a lot of metal-metal, lot of hemis.
Dr. Sculco: Same patient. If I have patient that is recurrently dislocating, 65-year-old man I probably would do a dual mobility in this day and age. If it’s an older female patient, particularly, who is frail and has poor proprioperception and poor tissues, I’m going to do a constrained liner.
Moderator Maloney: If the system allowed you to put in a constrained liner regardless of the system, you would give it a shot with a constrained liner.
Dr. Sculco: I would definitely in an older patient.
Dr. Lachiewicz: Two years ago, I did do that, Bill, because the patient was malnourished and it was a three-time acetabular revision. I didn’t want to put this patient through a two-hour surgery so I just changed the liner to a constrained liner. But I still have a lot of fear of constrained liners, Tom.
Dr. Sculco: Paul, don’t be afraid.
Moderator Maloney: Ladies and gentlemen, there is definitely a role for dual mobilities. There is also a role for constrained liners, but it’s shrinking. Thank you, gentlemen.
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