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Sonn KA, Meneghini RM. Adverse Local Tissue Reaction due to Acetabular Corrosion in Modular Dual-Mobility Constructs. Arthroplast Today 2020; 6:976-980. [PMID: 33385036 PMCID: PMC7772450 DOI: 10.1016/j.artd.2020.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 01/18/2023] Open
Abstract
Dual-mobility (DM) bearings in total hip arthroplasty (THA) have been reported to reduce dislocation rates, especially in high-risk patients, and are being rapidly adopted in primary and revision THAs. However, this technology introduces additional interfaces that have the potential to result in unforeseen complications. We present a series of 3 patients with mechanically assisted crevice corrosion at the acetabular component-metal dual-mobility liner interface. Consequently, we urge judicious use and close clinical observation of this new, effective technology in THA.
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Affiliation(s)
- Kevin A Sonn
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Cha YH, Yoo JI, Kim JT, Park CH, Ahn YS, Choy WS, Ha YC, Koo KH. Dual mobility total hip arthroplasty in the treatment of femoral neck fractures. Bone Joint J 2020; 102-B:1457-1466. [PMID: 33135437 DOI: 10.1302/0301-620x.102b11.bjj-2020-0610.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA). METHODS Studies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA. RESULTS A total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z -4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z -3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z -4.2). CONCLUSION While the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA. Cite this article: Bone Joint J 2020;102-B(11):1457-1466.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan-Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Sun Ahn
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgey, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Cha YH, Yoo JI, Kim JT, Park CH, Ahn YS, Choy WS, Ha YC, Koo KH. Dual mobility total hip arthroplasty in the treatment of femoral neck fractures. Bone Joint J 2020. [DOI: 10.1302/0301-620x.102b9.bjj-2020-0610.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AimsTo evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA).MethodsStudies were selected based on the following criteria: 1) study design (retrospective cohort studies, prospective cohort studies, retrospective comparative studies, prospective comparative studies, and randomized controlled studies (RCTs)); 2) study population (patients with femoral neck fracture); 3) intervention (DM-THA or BHA); and 4) outcomes (complications during postoperative follow-up and clinical results). Pooled meta-analysis was carried out to evaluate the dislocation rate after DM-THA and to compare outcomes between DM-THA and BHA.ResultsA total of 17 studies (ten cohort studies on DM-THA and seven comparative studies of DM-THA and BHA) were selected. These studies included 2,793 patients (2,799 hips), made up of 2,263 DM-THA patients (2,269 hips) and 530 BHA patients (530 hips). In all, 16 studies were analyzed to evaluate dislocation rate after DM-THA. The cumulative dislocation rate was 4% (95% confidence interval (CI) 3 to 5). Seven studies were analyzed to compare the rates dislocation and surgical-site infection. The rate of dislocation was significantly lower in the DM-THA group than in the BHA group (risk ratio (RR) 0.3; 95% CI 0.17 to 0.53, p < 0.001, Z −4.11). There was no significant difference in the rate of surgical-site infection between the two groups (p = 0.580). Six studies reported all-cause reoperations. The rate of reoperation was significantly lower in the DM-THA group than in the BHA group (RR 0.5; 95% CI 0.32 to 0.78, p = 0.003, Z −3.01). Five studies reported one-year mortality. The mortality rate was significantly lower in the DM-THA group than in the BHA group (RR 0.58 95% CI 0.45 to 0.75, p < 0.0001, Z −4.2).ConclusionWhile the evidence available consisted mainly of non-randomized studies, DM-THA appeared to be a viable option for patients with displaced fractures of the femoral neck, with better reported rates of dislocation, reoperation, and mortality than BHA.
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Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, Korea
| | - Chan-Ho Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Sun Ahn
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgey, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Khoshbin A, Haddad FS, Ward S, O hEireamhoin S, Wu J, Nherera L, Atrey A. A cost-effectiveness assessment of dual-mobility bearings in revision hip arthroplasty. Bone Joint J 2020; 102-B:1128-1135. [PMID: 32862681 PMCID: PMC7468559 DOI: 10.1302/0301-620x.102b9.bjj-2019-1742.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA. Methods We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA. Results At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years. Conclusion The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: Bone Joint J 2020;102-B(9):1128–1135.
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Affiliation(s)
- Amir Khoshbin
- University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - Sarah Ward
- University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
| | | | - James Wu
- University of Toronto, Toronto, Canada
| | | | - Amit Atrey
- University of Toronto, Toronto, Canada.,St Michael's Hospital, Toronto, Canada
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55
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Kummerant J, Wirries N, Derksen A, Budde S, Windhagen H, Floerkemeier T. The etiology of revision total hip arthroplasty: current trends in a retrospective survey of 3450 cases. Arch Orthop Trauma Surg 2020; 140:1265-1273. [PMID: 32607655 DOI: 10.1007/s00402-020-03514-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Over the last years, the design of implants, the surgical approaches, and diagnostic tools changed in primary and revision of total hip arthroplasty. A knowledge of the different causes for revision after total hip arthroplasty is essential to avoid complications and failures. The purpose of this study was to determine trends of the etiology of implant failures over the last years by analyzing indications of revision hip arthroplasty. METHODS All the patients who performed revision hip arthroplasties in our institution between 2001 and 2015 were reviewed retrospectively. Patient demographics, the indication for revision surgery as well as the procedure were assessed. Descriptive statistical analyses and association analyses were performed. RESULTS Within our collective of 3450 revision hip arthroplasties, a total of 20 different indications were identified and categorized. Overall, 80.8% of the revisions were categorized as aseptic, 19.2% as septic implant failures. Some recently debated diagnoses like low-grade infection showed a high increase in incidence, whereas classic failure mechanisms like polyethylene wear showed a decrease over the time. In addition, the data revealed that cup loosening caused more revision surgeries than stem loosening. CONCLUSION This study successfully updated the current knowledge of different failure mechanisms in revision hip arthroplasties. The data proved that cup loosening was the most common failure mechanism in older patients, while in young patients, septic complications showed a high incidence. Probably, due to improved diagnostic tools, the percentage of infection in revision hip arthroplasty increased over the years.
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Affiliation(s)
- Jonas Kummerant
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
- BG Unfallklinik Frankfurt am Main gGmbH, 60389, Frankfurt am Main, Germany
| | - Nils Wirries
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Alexander Derksen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Stefan Budde
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Thilo Floerkemeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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56
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[Hip-spine syndrome-current developments and state of the evidence]. DER ORTHOPADE 2020; 49:841-848. [PMID: 32857167 DOI: 10.1007/s00132-020-03972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The movements between the spine, pelvis and hip joints are coordinated to allow for a physiological balance of the upper body and the pelvis during sitting and standing. Degenerative changes or spondylodesis of the spine result in decreased pelvic mobility and can lead to increased rates of instability in the presence of total hip arthroplasty (THA). To reduce the risk of THA dislocation several authors have recently recommended functional radiographs of the spine and pelvis, as well as individual safe zones for THA components. The aim of this article is to summarize the current body of knowledge regarding the influence of spinopelvic alignment on THA and provide recommendations for everyday clinical practice.
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57
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Postero-posterolateral approach in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 44:2577-2585. [PMID: 32676781 PMCID: PMC7679294 DOI: 10.1007/s00264-020-04679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
Abstract
Introduction Evolving surgical techniques in total hip arthroplasty (THA) have sought to make the surgical procedures safer. This requires having highly reproducible incision landmarks and simplifying the procedures. The postero-posterolateral approach, a very posterior incision in the hip, meets those requirements. However, this has not helped to reduce the post-operative dislocation rate. The aim of this study was to assess the relevance of combining the postero-posterolateral approach and next-generation dual mobility cups (DMC) in terms of dislocation risk. Materials and methods One hundred and fifty-eight THA were performed consecutively using the postero-posterolateral approach on 150 patients, by a single surgeon, over a 49-month period (November 2010 to December 2014). All acetabular implants were impacted. Results Average length of the incision was 7 cm (6 to 9 cm). Mean duration of the surgical procedure was 75 minutes (40 to 100). Mean blood loss was estimated at 210 cc (25 to 410 cc). All patients could walk with assistance the day before transferring to a rehabilitation centre. There was one posterior dislocation (0.63%), without recurrence. Conclusion The straightforwardness and reproducibility of the anatomical landmarks used for the postero-posterolateral approach, added to the stability of the dual mobility cup, result in a safe combination in the therapeutic THA arsenal.
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Heckmann N, Weitzman DS, Jaffri H, Berry DJ, Springer BD, Lieberman JR. Trends in the use of dual mobility bearings in hip arthroplasty. Bone Joint J 2020; 102-B:27-32. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1669.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aims Dual mobility (DM) bearings are an attractive treatment option to obtain hip stability during challenging primary and revision total hip arthroplasty (THA) cases. The purpose of this study was to analyze data submitted to the American Joint Replacement Registry (AJRR) to characterize utilization trends of DM bearings in the USA. Methods All primary and revision THA procedures reported to AJRR from 2012 to 2018 were analyzed. Patients of all ages were included and subdivided into DM and traditional bearing surface cohorts. Patient demographics, geographical region, hospital size, and teaching affiliation were assessed. Associations were determined by chi-squared analysis and logistic regression was performed to assess outcome variables. Results A total of 406,900 primary and 34,745 revision THAs were identified, of which 35,455 (8.7%) and 8,031 (23.1%) received DM implants respectively. For primary THA, DM usage increased from 6.7% in 2012 to 12.0% in 2018. Among revision THA, DM use increased from 19.5% in 2012 to 30.6% in 2018. Patients < 50 years of age had the highest rates of DM implantation in every year examined. For each year of increase in age, there was a 0.4% decrease in the rate of DM utilization (odds ratio (OR) 0.996 (95% confidence interval (CI) 0.995 to 0.997); p < 0.001). Females were more likely to receive a DM implant compared to males (OR 1.077 (95% CI 1.054 to 1.100); p < 0.001). Major teaching institutions and smaller hospitals were associated with higher rates of utilization. DM articulations were used more commonly for dysplasia compared with osteoarthritis (OR 2.448 (95% CI 2.032 to 2.949); p < 0.001) during primary THA and for instability (OR 3.130 (95% CI 2.751 to 3.562) vs poly-wear; p < 0.001) in the revision setting. Conclusion DM articulations showed a marked increase in utilization during the period examined. Younger patient age, female sex, and hospital characteristics such as teaching status, smaller size, and geographical location were associated with increased utilization. DM articulations were used more frequently for primary THA in patients with dysplasia and for revision THA in patients being treated for instability. Cite this article: Bone Joint J 2020;102-B(7 Supple B):27–32.
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Affiliation(s)
- Nathanael Heckmann
- Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, California, USA
| | - Dena S. Weitzman
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Heena Jaffri
- American Academy of Orthopaedic Surgeons, Rosemont, Illinois, USA
| | - Daniel J. Berry
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota, USA
| | | | - J. R. Lieberman
- Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, California, USA
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Gibbs VN, McCulloch RA, Dhiman P, McGill A, Taylor AH, Palmer AJR, Kendrick BJL. Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture. Bone Joint J 2020; 102-B:580-585. [PMID: 32349604 DOI: 10.1302/0301-620x.102b5.bjj-2019-1673.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. METHODS The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. RESULTS A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. CONCLUSION Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580-585.
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Affiliation(s)
- Victoria N Gibbs
- The Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Robert A McCulloch
- Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Paula Dhiman
- Centre for Statistics in Medicine, Botnar Research Centre, Oxford, UK
| | - Andrew McGill
- Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK.,Nuffield Department of Anaesthetics, Oxford University NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Adrian H Taylor
- The Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Antony J R Palmer
- The Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
| | - Ben J L Kendrick
- The Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford University NHS Foundation Trust, Oxford, UK
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Labban J, Letissier H, Mertl P, Lefèvre C, Migaud H, Clavé A. The Lefèvre retentive cup compared with the dual mobility cup in total hip arthroplasty revision for dislocation. INTERNATIONAL ORTHOPAEDICS 2020; 44:1661-1667. [DOI: 10.1007/s00264-020-04601-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
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Jonker RC, van Beers LWAH, van der Wal BCH, Vogely HC, Parratte S, Castelein RM, Poolman RW. Can dual mobility cups prevent dislocation without increasing revision rates in primary total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2020; 106:509-517. [PMID: 32278733 DOI: 10.1016/j.otsr.2019.12.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dislocation is one of the leading causes for early revision surgery after total hip arthroplasty (THA). To address this problem, the dual mobility (DM) cup was developed in the 1970s by the French. Despite the increased and, in some countries, broad use of DM cups, high quality evidence of their effectiveness compared to traditional unipolar (UP) cups is lacking. There are a few well-conducted literature reviews, but the level of evidence of the included studies was moderate to low and the rates of revision were not specifically investigated. Therefore, we did a systematic review to investigate whether there is a difference in the rate of dislocations and revisions after primary THA with a DM cup or a UP cup. METHODS We conducted a systematic literature search in PubMed, Embase and Cochrane databases in July 2019. The articles were selected based upon their quality, relevance and measurement of the predictive factor. We used the MINORS criteria to determine the methodological quality of all studies. RESULTS The initial search resulted in 702 citations. After application of the inclusion and exclusion criteria, eight articles met our eligibility criteria and were graded. Included studies were of medium to low methodological quality with a mean score of 14/24 (11-16) points following the MINORS criteria. In the case-control studies, a total of 549 DM cups and 649 UP cups were included. In the registry studies, a total of 5.935 DM cups and 217.362 UP cups were included. In the case-control studies, one (0.2%) dislocation was reported for the DM cups and 46 (7.1%) for the UP cup (p=0.009, IQR=0.00-7.00). Nine (1.6%) revisions, of which zero due to dislocation, were reported for the DM cup and 39 (6.0%), of which 30 due to dislocation, for the UP cup (p=0.046, CI=-16.93-5.73). In the registry studies 161 (2.7%) revisions were reported for the DM cup, of which 14 (8.7%) due to dislocation. For the UP cup, 3.332 (1.5%) revisions were reported (p=0.275, IQR=41.00-866.25), of which 1.093 (32.8%) due to dislocation (p=0.050, IQR=3.50-293.25). CONCLUSION This review suggests lower rates of dislocation and lower rates of revision for dislocation in favor of the DM cups. Concluding, DM cups might be an effective solution to reduce dislocation in primary THA. To evaluate the efficacy of DM cups compared to UP cups, an economic evaluation alongside a randomized controlled trial is needed focusing on patient important endpoints. LEVEL OF EVIDENCE III, systematic review of level III studies.
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Affiliation(s)
- Ragna C Jonker
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands
| | - Bart C H van der Wal
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - H Charles Vogely
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sebastien Parratte
- Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, PO Box 95500, 1090 HM Amsterdam, The Netherlands; Department of Orthopaedic Surgery, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
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Laende EK, Richardson CG, Dunbar MJ. Migration and Wear of a Dual Mobility Acetabular Construct at 3 Years Measured by Radiostereometric Analysis. J Arthroplasty 2020; 35:1109-1116. [PMID: 31866254 DOI: 10.1016/j.arth.2019.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The anatomic dual mobility (ADM) acetabular component was introduced because of previously described low dislocation rates for this type of construct. The shape of the anatomic cup and the motion of polyethylene liner may have implications for acetabular cup fixation and polyethylene liner wear; therefore, the purpose of this study was to assess the migration patterns and wear rates of the ADM component using radiostereometric analysis. METHODS Uncemented ADM acetabular components were implanted in 27 patients. Radiostereometric analysis exams were taken at 6 follow-up visits over 3 years. Proximal translation and sagittal rotation of the cup and polyethylene total wear and wear rates were calculated. Oxford 12 Hip scores and satisfaction were recorded. RESULTS Mean proximal translation was below the 0.2 mm threshold at 2 years associated with acceptable long-term survivorship (0.16 mm [standard deviation {SD} 0.31] at 3 years). Mean sagittal rotation was 0.29 degrees (SD 1.03) and was greater in female subjects (P < .001). Following bedding-in, the annual wear rate was 0.02 mm/y, below the 0.1 mm/y threshold. There was no association between cup migration and polyethylene wear. Patient satisfaction at 3 years was 96%. Mean Oxford 12 Hip scores improved from 21 (SD 7) preoperatively to 43 (SD 7) 3 years postoperatively. CONCLUSIONS The ADM cup demonstrated stable migration at 3 years indicating low risk for aseptic loosening. Bedding-in in the first year was followed by low annual wear rates. These finding suggest no increased risk of the dual mobility and anatomic design on fixation or wear.
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Affiliation(s)
- Elise K Laende
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C Glen Richardson
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedics, Department of Surgery, Dalhousie University and QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Nessler JM, Malkani AL, Sachdeva S, Nessler JP, Westrich G, Harwin SF, Mayman D, Jerabek S. Use of dual mobility cups in patients undergoing primary total hip arthroplasty with prior lumbar spine fusion. INTERNATIONAL ORTHOPAEDICS 2020; 44:857-862. [PMID: 32077995 DOI: 10.1007/s00264-020-04507-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients undergoing primary total hip arthroplasty (THA) with prior lumbar spine fusion (LSF) are a high-risk group for instability with reported incidence of dislocation as high as 8.3% using fixed bearing femoral heads. Purpose of this study was to determine risk of post-operative instability in patients undergoing primary THA with a history of prior LSF using dual mobility acetabular cups. METHODS This was a multicenter retrospective study with 93 patients undergoing primary THA using a dual mobility cup with a prior history of instrumented LSF. There were 56 females and 47 males with an average age of 66 years (46-87) and average BMI of 30 with mean follow-up of 2.7 years (range 12-124 months). Surgical approach included posterior (63), direct lateral (15), anterior (11), and direct superior (4). Forty-four percent had one level lumbar fusion, 29% with two levels, and 15% with three or more levels fused. The primary outcome investigated was instability. RESULTS There were no cases of instability or prosthetic joint infection in this group of patients with prior lumbar spine fusion undergoing primary THA using a dual mobility cup. There was one intra-operative periprosthetic femur fracture and one case of aseptic acetabular cup loosening. CONCLUSION Patients undergoing THA with prior LSF are at increased risk for instability due to loss of normal spinopelvic relationship. The use of dual mobility cups in patients with prior LSF undergoing primary THA appears promising with no cases of instability in this high-risk group of patients.
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Affiliation(s)
- Joseph M Nessler
- University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Arthur L Malkani
- Adult Reconstruction Program, University of Louisville, 550 South Jackson Street, Louisville, KY, 40202, USA.
| | - Shikha Sachdeva
- Department of Orthopaedic Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY, 40202, USA
| | - Joseph P Nessler
- St. Cloud Orthopedics, 1901 Connecticut Ave S, Sartell, MN, 56377, USA
| | - Geoff Westrich
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Steven F Harwin
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029-5674, USA
| | - David Mayman
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Seth Jerabek
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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Lack of early dislocation for dual mobility vs. fixed bearing total hip arthroplasty: A multi-center analysis of comparable cohorts. J Orthop 2020; 21:1-5. [PMID: 32071524 DOI: 10.1016/j.jor.2020.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background Dislocation is a major cause of morbidity and revision surgery following total hip arthroplasty (THA). To address such issues, dual mobility (DM) bearings were introduced as a more stable alternative to fixed-bearing (FB) prostheses. As such, we compared DM and FB systems in a cohort study in terms of dislocations, readmissions, and revisions. Methods A 27 multi-center retrospective review was performed of 664 DM and 218 FB cases from the same manufacturer with mean follow-up of 2.09 years and 1.83 years, respectively. Patient reported outcome measures (PROMs) including Harris Hip Score (HHS), SF12, EQ5D, and Lower Extremity Activity Score (LEAS) were evaluated as well as dislocation rates, readmissions, and revisions rates. We also performed a survivorship analysis through Kaplan-Meier estimator. Students t-test was used for normally distributed continuous data and Fisher exact test (P < 0.05) was used for discrete data. Results There were 0 dislocations in the DM (0%) group and 2 dislocations in the FB (0.92%) group (p = 0.06). Latest follow up HHS revealed a significant difference between groups (91.44 DM and 87.81 FB; p = 0.006). In addition, there was significant difference between DM and FB on SF12 Physical Component Score (PCS) (46.83 and 44.55, respectively, p = 0.015). Also, readmission rates at 30, 60 and 90 days remained lower for DM than for FB at each time point (1.05% vs. 2.75%, 1.81% vs. 2.75%, and 1.81% vs. 2.75, respectively). Overall, DM had a lower revision rate at 1.51% compared to 2.29% for FB (p = 0.24). The revision breakdown for DM revealed 0 (0%) for both Anatomic Dual Mobility (ADM) and Modular Dual Mobility (MDM) due to the acetabular component.) There was a difference, 14 (87.5%) for ADM and 2 (12.5%) due to the femoral component. The survivorship analysis revealed no significance difference between DM and FB at 4 years (97.90% and 97.26%, respectively). Conclusion In comparison to patients who undergo FB THA, DM bearings have improved PROMs and a lower rate of dislocation, readmission, and revision.
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Schmidt A, Batailler C, Fary C, Servien E, Lustig S. Dual Mobility Cups in Revision Total Hip Arthroplasty: Efficient Strategy to Decrease Dislocation Risk. J Arthroplasty 2020; 35:500-507. [PMID: 31563399 DOI: 10.1016/j.arth.2019.08.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/11/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (rTHA) is a challenging surgery with a higher rate of complications than primary arthroplasty, particularly instability and aseptic loosening. The purpose of this study is to compare dual mobility cup (DMC) and standard mobility cup (SMC) in all rTHAs performed at our institution over a decade with a 1 year minimum follow-up. METHODS Two hundred ninety-five rTHAs (acetabular only and bipolar revisions) between 2006 and 2016 were retrospectively reviewed. These were divided into those with a DMC (184 revisions) or SMC (111 revisions). Dislocation and complications requiring re-revision were reported. RESULTS The rTHA mean age was 69 years ± 13.9 (19-92) and the mean follow-up was 2.3 years. Dislocation risk was statistically lower (P = .01) with a DMC (3.8%; 7/184) than with an SMC (13.5%; 15/111). DMC required re-rTHA in 24/184 (13%) for any reason compared to SMC in 19/111 (17.1%) (P = .34). There was no significant difference in early aseptic loosening (P = .28) between the 2 groups. For young patients (≤55 years), results were similar with a lower dislocation rate in the DMC group (P = .24) and no increased risk of early aseptic loosening (P = .49). CONCLUSION This study demonstrates that for all rTHA indications DMC compared to SMC has a significantly decreased risk of postoperative dislocation without risk of early aseptic loosening at medium term follow-up. The use of DMC in rTHA is an important consideration particularly with the predicted increased incidence of both primary and revision THA globally.
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Affiliation(s)
- Axel Schmidt
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Lyon, France
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Fessy MH, Jacquot L, Rollier JC, Chouteau J, Ait-Si-Selmi T, Bothorel H, Chatelet JC. Midterm Clinical and Radiographic Outcomes of a Contemporary Monoblock Dual-Mobility Cup in Uncemented Total Hip Arthroplasty. J Arthroplasty 2019; 34:2983-2991. [PMID: 31444020 DOI: 10.1016/j.arth.2019.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The efficacy of contemporary monoblock dual-mobility (DM) cups to prevent dislocations in total hip arthroplasty (THA) is well reported, but there is little published data on their mid- to long-term outcomes. The authors aimed at reporting the 10-year survival of a contemporary DM cup as well as its clinical and radiographic outcomes. METHODS From a retrospective consecutive multicentric series of 516 patients (541 hips) that received uncemented THA between June 2007 and June 2010, 6 patients (6 hips) had cup and stem revisions, 5 patients (5 hips) had isolated stem revision, and 2 patients (2 hips) had isolated insert revision. A total of 103 patients (111 hips) died with their original implants, and 41 patients (42 hips) were lost to follow-up. This left 358 patients (375 hips) for clinical assessment at a median follow-up of 8.7 years (range, 6.8-10.5 years), including 279 patients (290 hips) with postoperative radiographs. Implant survival was calculated using the Kaplan-Meier method, and multivariable analyses were performed to determine whether clinical outcomes are associated with patient or surgical factors. RESULTS The 10-year survival considering revision for aseptic loosening as end point was 100% for the cup and 99.2% for the stem. No dislocations were observed, and radiographic assessment revealed 1 acetabular granuloma (0.3%), but no radiolucencies nor fractures. The Harris hip score improved from 49.6 ± 15.5 to 85.2 ± 14.5, and the postoperative Oxford hip score was 19.2 ± 7.6. Multivariable analyses revealed that improvement in Harris hip score increased with cup diameter (beta, 1.28; P = .039). CONCLUSION Our data confirmed satisfactory midterm outcomes of uncemented THA using a contemporary DM cup, with no dislocations nor cup revisions due to aseptic loosening. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Michel-Henri Fessy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cedex, France; IFSTTAR, UMRT_9406, Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France; Artro Group Institute, Lyon, France
| | - Laurent Jacquot
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Jean-Charles Rollier
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Julien Chouteau
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Department of Orthopaedic Surgery, Clinique d'Argonay, Annecy, France
| | - Tarik Ait-Si-Selmi
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Jean-Christophe Chatelet
- Artro Group Institute, Lyon, France; Ramsay Générale de Santé, Centre de Chirurgie Orthopédique du Beaujolais, Arnas, France
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Gaillard R, Kenney R, Delalande JL, Batailler C, Lustig S. Ten- to 16-Year Results of a Modern Cementless Dual-Mobility Acetabular Implant in Primary Total Hip Arthroplasty. J Arthroplasty 2019; 34:2704-2710. [PMID: 31353249 DOI: 10.1016/j.arth.2019.06.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/06/2019] [Accepted: 06/22/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to assess the radiographic results, clinical outcomes, and survivorship of a modern cementless dual-mobility cup (DMC) implant as a primary THA with a minimum of 10 years follow-up. METHODS This study retrospectively assessed a series of 310 primary THAs using a modern-generation cementless DMC (Saturne acetabular cup) between April 2001 and December 2005 at a single center. Patients were followed prospectively clinically and radiographically after surgery. Hips with follow-up less than 120 months were excluded from the study (5 lost to follow-up and 167 deceased). In total, a cohort of 138 hips were included for preoperative and postoperative analysis with an average follow-up of 152.4 months. All complications were collected, and a Kaplan-Meier survival analysis was performed. RESULTS There was a significant increase in the mean Harris and Postel-Merle d'Aubigne scores between preoperative and postoperative cohorts (P < .001). No loosening of the cup and no acetabular osteolysis were found at final follow-up. No prosthetic dislocation, no intraprosthetic dislocation, and no infections were reported. The survival curve of THA in the total cohort (N = 310) was about 98% at 10 years with 3 stem revisions for femoral fracture. One psoas impingement was also described. CONCLUSION This study showed no acetabular component failure and no reported cases of acetabular osteolysis with this DMC acetabular component retention at 10 years. No prosthetic or intraprosthetic dislocation was reported.
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Affiliation(s)
| | - Raymond Kenney
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY
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Kunutsor SK, Barrett MC, Beswick AD, Judge A, Blom AW, Wylde V, Whitehouse MR. Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements. THE LANCET. RHEUMATOLOGY 2019; 1:e111-e121. [PMID: 38229338 DOI: 10.1016/s2665-9913(19)30045-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dislocation following total hip replacement is associated with repeated admissions to hospital and substantial costs to the health system. Factors influencing dislocation following primary total hip replacement are not well understood. We aimed to assess the association of various factors with dislocation risk following primary total hip replacement. METHODS We did a systematic review and meta-analysis of longitudinal studies reporting associations of patient-related, surgery-related, implant-related, and hospital-related factors with dislocation risk after primary total hip replacement. We searched MEDLINE, Embase, Web of Science, and the Cochrane Library for all relevant articles published up to March 8, 2019. Summary measures of association were calculated with relative risks (RRs) and 95% CIs. This study is registered on PROSPERO, number CRD42019121378. FINDINGS We identified 149 articles based on 125 unique studies with data on 4 633 935 primary total hip replacements and 35 264 dislocations. The incidence of dislocation ranged from 0·12% to 16·13%, with an overall pooled incidence of 2·10% (95% CI 1·83-2·38) over a weighted mean follow-up duration of 6 years. Based on the median year of data collection, a significant decline in dislocation rates was observed from 1971 to 2015. The risk of dislocation did not differ significantly between male versus female patients (RR 0·97; 95% CI 0·88-1·08), was higher in those aged 70 years and older than in those younger than 70 years (1·27; 1·02-1·57), and was lower in those from high versus low income groups (0·79; 0·74-0·85). White ethnicity (only when compared with Asian ethnicity), drug use disorder, and social deprivation were significantly associated with increased dislocation risk. The risk of dislocation was higher in patients with body-mass index (BMI) of 30 kg/m2 or higher than in those with BMI lower than 30 kg/m2 (RR 1·38; 95% CI 1·03-1·85). Medical factors and those related to surgical history that were significantly associated with increased dislocation risk included neurological disorder, psychiatric disease, comorbidity indices, previous surgery including spinal fusion, and surgical indications including avascular necrosis, rheumatoid arthritis, inflammatory arthritis, and osteonecrosis. Surgical factors such as the anterolateral, direct anterior, or lateral approach, and posterior approach with short external rotator and capsule repair were significantly associated with reduced dislocation risk. At the implant level, larger femoral head diameters, elevated acetabular liners, dual mobility cups, cemented fixations, and standard femoral neck lengths significantly reduced the risk of dislocation. Hospital-related factors such as experienced surgeons and high surgeon procedure volume significantly reduced the risk of dislocation. INTERPRETATION Dislocation following primary total hip replacement has declined over time. Surgical approaches that reduce dislocation risk can be used by clinicians during primary total hip replacement, and alternative bearings such as dual mobility can be used in individuals at high risk of dislocation. Modifiable risk factors such as high BMI and comorbidities might also be amenable to optimisation before surgery. FUNDING National Institute for Health Research.
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Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK.
| | | | - Andrew D Beswick
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Andrew Judge
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Vikki Wylde
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
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Chalmers BP, Mangold DG, Hanssen AD, Pagnano MW, Trousdale RT, Abdel MP. Uniformly low serum cobalt levels after modular dual-mobility total hip arthroplasties with ceramic heads: a prospective study in high-risk patients. Bone Joint J 2019; 101-B:57-61. [PMID: 31146553 DOI: 10.1302/0301-620x.101b6.bjj-2018-1403.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. PATIENTS AND METHODS Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively. RESULTS Mean Co and Cr levels were 0.30 μg/l and 0.76 μg/l, respectively, at the most recent follow-up. No patient had a Co level ≥ 1 μg/l. Only one patient had a Cr level ≥ 1 μg/l. That patient's Cr level was 12 μg/l at 57 months after revision THA for ALTR (and decreased ten-fold from a preoperative Cr of 113 μg/l). CONCLUSION At a mean of four years, no patient with a modular dual-mobility construct and ceramic femoral head had elevated Co levels, including seven patients revised specifically for ALTR. While further studies are required, we support the selective use of a modular dual-mobility construct in revision and complex primary THAs for patients at high risk for instability. Cite this article: Bone Joint J 2019;101-B(6 Supple B):57-61.
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Affiliation(s)
- B P Chalmers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D G Mangold
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R T Trousdale
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Ouanezar H, Jalaguier T, Franck F, Pibarot V, Bothorel H, Saffarini M, Piton JP. Mid-term outcomes of titanium modular neck femoral stems in revision total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:92. [PMID: 31019942 DOI: 10.21037/atm.2019.01.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Modular stems have been widely studied as they allow intraoperative adjustments (offset, anteversion, limb length) to better restore hip biomechanics. Many authors reported outcomes of revision total hip arthroplasty (THA) using modular stems with metaphyseal-diaphyseal junctions, however, little is known about modular neck femoral stems (MNFS) with metaphyseal-epiphyseal junctions. We therefore aimed to report outcomes and implant survival of a MNFS in a consecutive series of revision THA at a minimum follow-up of 5 years. Methods We reviewed a consecutive series of 28 revision THAs performed between February 2010 and March 2012 using an uncemented MNFS. The final study cohort included 25 patients living with their original components, at a mean follow-up of 68.4±7.4 months and aged 67.7±11.6 years at index operation. Results The Harris Hip Score (HHS) improved from 39.1±19.2 pre-operatively to 78.1±18.3 post-operatively, and the Postel Merle d'Aubigné score (PMA) improved from 9.8±3.0 pre-operatively to 14.8±2.8 post-operatively. The postoperative limb length discrepancy (LLD) was >10 mm in 18% of the hips. There were no significant differences of femoral offset and neck shaft angle (NSA) between operated and contralateral hips. Two hips (8.0%) showed new periprosthetic radiolucent lines. Periprosthetic fractures (PPF) occurred in 3 hips (12%). No subluxations, dislocations or implant breakages were reported. One revision (3.6%) was performed with retrieval of the revision stem for infection. The Kaplan-Meier (KM) survival at 5 years, using stem revision as endpoint, was 96.0%. Conclusions The Optimal® MNFS provided a satisfactory survival and clinical outcomes at 5 years, with no noticeable adverse effects resulting from the additional modular junction.
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Affiliation(s)
- Hervé Ouanezar
- Department of Orthopaedic Surgery, Pavillon T, Hôpital Universitaire Edouard Herriot, Lyon, France
| | - Thomas Jalaguier
- Department of Orthopaedic Surgery, Pavillon T, Hôpital Universitaire Edouard Herriot, Lyon, France
| | - Florent Franck
- Department of Orthopaedic Surgery, Pavillon T, Hôpital Universitaire Edouard Herriot, Lyon, France
| | - Vincent Pibarot
- Department of Orthopaedic Surgery, Pavillon T, Hôpital Universitaire Edouard Herriot, Lyon, France
| | | | | | - Jean-Pierre Piton
- Department of Orthopaedic Surgery, Hôpital Belle-Isle, Hôpitaux Privés de Metz, Metz, France
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A comparative study about the incidence of dislocation and peri-prosthetic fracture between dual mobility versus standard cups after primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:2691-2695. [DOI: 10.1007/s00264-018-4279-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/18/2018] [Indexed: 01/18/2023]
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Assi C, Caton J, Fawaz W, Samaha C, Yammine K. Revision total hip arthroplasty with a Kerboull plate: comparative outcomes using standard versus dual mobility cups. INTERNATIONAL ORTHOPAEDICS 2018; 43:2245-2251. [PMID: 30370452 DOI: 10.1007/s00264-018-4209-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability is a major complication in revision total hip arthroplasty (THA). Dual mobility (DM) cups were shown to reduce the risk of post-operative implant dislocation. Few case-series studies assessed the outcomes of cemented DM cups when associated to acetabular reconstruction antiprotrusio cages. No published comparative studies were found to look for outcome differences between standard cups (SC) and DM cups in first revision THA associated with a Kerboull plate (KP) and acetabular bone grafting. MATERIALS AND METHODS This is a retrospective comparative study of two groups of patients in two institutions. All cases were first revision THA with KP reconstruction; a cemented standard cup (SC) was used in one institution (THA-SC group) while a cemented DM cup was used in the second institution (THA-DM group). The posterolateral approach and the same technique for KP placement, the cross technique, were performed in both groups. Primary outcomes were dislocation and revision rates. Survivorship and clinical and radiological results were set to be secondary outcomes. There were ten patients (13 hips) in the first group and 16 patients (16 hips) in the second with a mean follow-up clinical and radiological evaluation of 74.2 ± 47.9 months. RESULTS Besides age, no significant demographic differences were present between both groups. There were three dislocations (23%) in the first group treated with close reduction compared to none in the second (p = 0.04). No further episode of dislocation or revision surgery occurred until the last follow-up in both groups. The mean Harris Hip Scores for the THA-SC and THA-DM groups were 87.5 ± 10.9 and 87.4 ± 12.1, respectively. When present, radiolucent lines were less than 1 mm thick and were non-progressive in both groups. In all patients, complete trabeculation remodeling or cortical repair of the graft was observed. CONCLUSION The cup type was the single variable which could account for the observed dislocation rate difference. The mid-term results of using DM cups with KP in first revision THA seem very encouraging. Our findings add to the previously published results on the excellent outcomes in terms of stability in revision THA when using DM cups.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | | | - Wissam Fawaz
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Camille Samaha
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Beirut, Lebanon. .,Center for Evidence-Based Anatomy, Sports & Orthopedic Research, Beirut, Lebanon.
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Komiyama K, Fukushi JI, Motomura G, Hamai S, Ikemura S, Fujii M, Nakashima Y. Does high hip centre affect dislocation after total hip arthroplasty for developmental dysplasia of the hip? INTERNATIONAL ORTHOPAEDICS 2018; 43:2057-2063. [DOI: 10.1007/s00264-018-4154-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/10/2018] [Indexed: 01/10/2023]
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