ORIGINAL PAPER Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation Cécile Batailler 1 & Camdon Fary 2 & Pierre Batailler 3 & Elvire Servien 1 & Philippe Neyret 1 & Sébastien Lustig 1 Received: 27 August 2016 /Accepted: 31 October 2016 # SICOT aisbl 2016 Abstract Aim We hypothesize that a dual mobility cup can be safely used via the direct anterior approach, without increasing the risk of complications or incorrect positioning. Materials and methods This retrospective study compared 201 primary total hip arthroplasties using a dual mobility cup performed via direct anterior approach without a traction table, to 101 arthroplasties performed via posterolateral ap- proach. Implant positioning, function scores, and early com- plications were recorded. Results Implant positioning was appropriate in both groups, with a higher cup anteversion in direct anterior approach. The complications rates were similar in both groups, with no dis- location or infection. Conclusion The direct anterior approach without traction ta- ble associated with a dual mobility cup does not increase the risk of complications or non-optimal positioning of implants. This strategy is interesting for patients with high risk of post- operative dislocation. Keywords Direct anterior approach . Dislocation . Dual mobility cup . Implants positioning . Total hip arthroplasty Introduction Postoperative dislocations represent a major complication af- ter total hip arthroplasty (THA), with a reported incidence by posterolateral approach (PLA) in primary and revision surgery as high as 7 % and 25 % respectively [1], and a risk which increased by 1 % each five years according to Berry [2] and 1.39 % according to Caton [3]. The PLA is the most common- ly used and taught approach internationally. To decrease the risk of dislocation from the PLA alternative surgical ap- proaches and implants have been trialed. The direct anterior approach (DAA) is considered to have a lower dislocation risk related to muscle and posterior capsule preservation [4]. Hueter then Judet were the first to describe this approach in the 1950s [5]. It became increasingly popular following Siguier [6] and Matta’ s publications [7] which re- ported further advantages of less soft tissue trauma, faster recovery and lower dislocation rate. However, since the de- velopment of the minimally invasive posterior approach (MPA) these benefits are less obvious [8]. The dual mobility cup (DMC), developed by Bousquet in 1974 [9] to reduce dislocation rate, was initially limited to patients with a high dislocation risk due to concerns of exces- sive polyethylene wear. Also an initial concern of these cups was that as they exceeded a hemisphere in shape there was a higher risk of psoas impingement as it passed over the ex- posed rim [10, 11]. The cups have been progressively devel- oped, with cups of first, second or third generation, including the introduction of highly cross-linked polyethylene [12] and have had excellent long-term results [13]. Recent literature reports a dislocation risk up to 2.7 % with DAA [7, 14] and up to 1.4 % with DMC via PLA [15]. To our knowledge no study has reported the results of DMC via DAA, which combines a technically demanding approach with a cup exceeding a hemisphere. The aim of this study * Sébastien Lustig Sebastien.lustig@gmail.com 1 Albert Trillat Center, Lyon North University Hospital, Lyon, France 2 Western Hospital, Melbourne, Australia 3 Public Health Center, Grenoble University Hospital, Grenoble, France International Orthopaedics (SICOT) DOI 10.1007/s00264-016-3333-x